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Montana rates for HCPCS 67221

Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)

Facilitymedian $437 · 10th–90th $347–$5010%20%10th90th$437Professionalmedian $316 · 10th–90th $186–$6460%10%10th90th$316$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $295.12 / $645.65
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$323.59 / $323.59 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$213.80 / $323.59 / $426.58
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$346.74 / $457.09 / $501.19
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $457.09 / $501.19
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$251.19 / $354.81 / $489.78
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $288.40 / $467.74
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$363.08 / $363.08 / $398.11
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $416.87 / $562.34