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Wisconsin rates for HCPCS 65091

Evisceration Ocular Contents W/O Implant

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.92 / $2,713.53 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,169.00 / $8,408.00 / $12,444.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,000.49 / $2,337.73 / $3,770.67
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.69 / $921.59 / $1,365.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.26 / $4,240.00 / $11,598.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.69 / $921.59 / $1,520.24
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,314.00 / $1,734.48 / $2,462.00
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,001.70 / $9,001.70 / $9,001.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00