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North Carolina 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
$200.98 / $388.50 / $5,449.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $260.24 / $453.43
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.98 / $405.48 / $655.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.98 / $320.54 / $695.85
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.98 / $325.67 / $498.50
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$345.72 / $354.00 / $354.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$905.00 / $2,417.00 / $4,102.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.67 / $301.63 / $704.88
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $1,649.69
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,511.20 / $2,038.48 / $2,318.03