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Wisconsin rates for HCPCS 67221

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

Facilitymedian $2,884 · 10th–90th $427$5,7540%10%10th90th$2,884Professionalmedian $324 · 10th–90th $200$9770%10%10th90th$324$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $588.84 / $1,905.46
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $288.40 / $588.84
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $398.11 / $1,096.48
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $851.14 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $616.60 / $1,258.93
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $416.87 / $6,918.31
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $575.44 / $776.25
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $416.87 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $602.56 / $2,041.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $380.19
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$436.52 / $2,951.21 / $3,235.94
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $758.58 / $1,047.13
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$309.03 / $549.54 / $977.24
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$575.44 / $1,659.59 / $1,659.59
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $1,258.93 / $2,041.74
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $977.24 / $1,288.25
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$489.78 / $489.78 / $489.78
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,995.26 / $2,630.27
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,754.23 / $5,011.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $512.86 / $1,659.59