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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
$275.42 / $3,801.89 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$199.53 / $288.40 / $512.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $4,466.84 / $8,709.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $204.17 / $346.74
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $208.93
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $346.74 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $288.40 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $2,818.38 / $4,265.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $281.84 / $457.09