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Tennessee 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
$452.00 / $2,133.00 / $7,602.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $264.05 / $390.36
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.35 / $187.35 / $398.12
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$764.00 / $1,487.00 / $2,257.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.99 / $309.00 / $594.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.47 / $305.11 / $544.66
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,649.69 / $1,690.08
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,511.20 / $2,025.28 / $2,318.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.00 / $1,560.00 / $2,914.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$244.18 / $316.00 / $620.15