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Washington rates for HCPCS 67221

Dstrj Lesion Choroid Photodynamic Therapy

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.98 / $818.29 / $14,464.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.74 / $279.30 / $525.05
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.53 / $1,646.32 / $3,151.02
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.55 / $583.29 / $2,025.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$357.02 / $357.02 / $479.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.89 / $391.86 / $761.34
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$182.14 / $359.71 / $684.47
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.28 / $372.60 / $672.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.33 / $406.73 / $704.16
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$356.40 / $522.99 / $557.44
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.53 / $359.68 / $369.26
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.24 / $484.71 / $682.71
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,201.98 / $1,646.32 / $3,151.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$278.12 / $470.60 / $666.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$332.00 / $648.00 / $4,611.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$338.00 / $437.79 / $775.34