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New Mexico rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.38 / $2,145.78 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $253.90 / $478.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.85 / $292.70 / $452.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $875.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$188.50 / $332.43 / $478.45
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $227.59 / $421.68
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$232.55 / $310.44 / $414.56
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.64 / $330.00 / $478.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$350.00 / $2,358.00 / $2,877.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$312.00 / $385.01 / $560.17