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Michigan 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
$270.64 / $947.70 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $257.05 / $453.43
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$461.50 / $461.50 / $461.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$771.94 / $899.72 / $1,218.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.23 / $245.80 / $414.79
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.99 / $264.08 / $442.82
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$287.31 / $947.70 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$220.51 / $287.31 / $466.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$221.82 / $271.66 / $371.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.00 / $2,800.00 / $4,594.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.62 / $331.53 / $439.56