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Idaho rates for HCPCS 67221

Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,407.00 / $4,500.00 / $7,045.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $306.64 / $586.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$214.35 / $319.98 / $437.42
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$207.35 / $409.58 / $621.58
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.06 / $399.16 / $524.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $492.36
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,042.08 / $1,394.94 / $1,770.12
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$339.30 / $414.26 / $538.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $2,620.00 / $4,441.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.52 / $390.04 / $557.19