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Utah 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
$295.12 / $3,388.44 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $275.42 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $323.59 / $467.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $457.09
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $977.24 / $2,238.72
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $416.87 / $602.56
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $501.19 / $707.95
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $309.03 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $2,818.38 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $269.15 / $407.38