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South Carolina rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$260.58 / $3,776.00 / $9,727.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.55 / $260.58 / $349.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.47 / $1,397.06 / $2,318.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.64 / $372.03 / $540.22
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$246.45 / $246.45 / $246.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$223.37 / $318.00 / $583.77
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.05 / $326.00 / $488.43
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.35 / $231.35 / $231.35
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$212.39 / $276.91 / $350.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$461.00 / $3,866.00 / $6,584.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$237.11 / $292.01 / $488.36