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Pennsylvania 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
$294.20 / $2,240.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $255.08 / $432.32
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.97 / $285.35 / $513.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.00 / $358.00 / $358.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.61 / $272.38 / $424.99
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$332.24 / $332.24 / $428.43
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$318.42 / $327.00 / $416.36
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$594.00 / $2,371.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$201.88 / $270.99 / $705.86
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$394.90 / $394.90 / $394.90
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$358.00 / $358.00 / $358.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.79 / $272.04 / $407.39
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$200.77 / $262.11 / $387.53
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.45 / $260.39 / $387.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$412.00 / $1,219.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$258.54 / $332.69 / $526.76