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Missouri rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$324.45 / $2,598.00 / $7,365.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.55 / $250.43 / $381.28
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.11 / $361.11 / $361.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,852.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.40 / $294.19 / $424.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.85 / $166.85 / $386.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.45 / $320.66 / $577.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $466.60 / $1,836.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$271.06 / $365.55 / $2,025.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $1,632.00 / $2,664.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.11 / $336.53 / $561.64