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Vermont rates for HCPCS 67221

Destruction of localized lesion of choroid (eg, choroidal neovascularization); photodynamic therapy (includes intravenous infusion)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $288.40 / $512.86
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $489.78 / $977.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $354.81 / $489.78
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $977.24
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $363.08 / $870.96