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Indiana 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
$195.19 / $543.00 / $5,634.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$195.19 / $255.08 / $344.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$856.00 / $4,320.00 / $8,230.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.60 / $205.58 / $283.70
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$168.59 / $245.57 / $336.19
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$254.81 / $318.51 / $353.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.47 / $347.89 / $450.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$217.20 / $295.26 / $474.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.00 / $2,811.00 / $4,271.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.10 / $308.05 / $545.79