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Michigan rates for HCPCS 67500

Retrobulbar injection; medication (separate procedure, does not include supply of medication)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.91 / $100.16 / $4,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.12 / $83.91 / $103.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$341.88 / $398.47 / $539.87
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.32 / $91.30 / $144.16
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.54 / $73.33 / $137.88
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.95 / $83.91 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.47 / $85.28 / $121.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.45 / $67.94 / $92.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $1,386.00 / $2,449.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.18 / $93.78 / $129.15