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Utah rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$222.90 / $2,910.00 / $4,725.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.95 / $238.18 / $450.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.80 / $325.44 / $463.09
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.95 / $229.22 / $297.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$832.54 / $1,102.11 / $1,606.11
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.60 / $383.50 / $560.25
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,106.00 / $1,649.00 / $2,824.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$238.00 / $286.56 / $450.10