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Louisiana rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$362.32 / $1,236.00 / $3,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $325.39 / $463.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$502.32 / $981.62 / $1,426.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.74 / $318.02 / $418.23
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $40.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.00 / $451.00 / $451.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$202.38 / $288.00 / $435.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$341.00 / $1,049.00 / $2,271.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.82 / $312.00 / $556.64