go back

New Hampshire 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
$741.31 / $1,819.70 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$208.93 / $281.84 / $436.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,412.54 / $2,630.27
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.82 / $346.74 / $537.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$269.15 / $436.52 / $645.65
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $7,943.28 / $7,943.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $380.19 / $758.58
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,943.28 / $7,943.28 / $7,943.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$251.19 / $389.05 / $794.33