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Nebraska 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
$253.56 / $4,241.22 / $13,841.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.53 / $318.76 / $1,114.28
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.16 / $615.16 / $615.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,180.02 / $5,453.87 / $10,634.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.06 / $360.37 / $510.88
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.10 / $226.10 / $226.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.23 / $623.10 / $809.29
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.24 / $481.76 / $1,775.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$399.45 / $572.54 / $787.09
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$248.70 / $498.91 / $713.57
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$418.75 / $569.12 / $722.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,775.00 / $3,227.00 / $6,169.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.68 / $591.19 / $654.95