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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
$1,412.54 / $4,466.84 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $316.23 / $645.65
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$295.12 / $758.58 / $1,513.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $416.87 / $562.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $331.13 / $467.74
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $398.11 / $831.76
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $346.74 / $562.34
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,318.26 / $1,862.09
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$275.42 / $426.58 / $575.44
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $346.74 / $1,230.27
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $2,630.27 / $4,466.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $338.84 / $512.86