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West Virginia 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
$210.56 / $270.99 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.62 / $253.90 / $364.29
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$216.96 / $237.35 / $258.58
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.86 / $266.33 / $339.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.89 / $347.89 / $347.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.16 / $307.95 / $961.98
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,488.35 / $1,488.35 / $1,488.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.66 / $312.00 / $509.14