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Wisconsin rates for HCPCS 65125

Modification of ocular implant with placement or replacement of pegs (eg, drilling receptacle for prosthesis appendage) (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $691.83 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $446.68 / $741.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,786.30 / $7,585.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $602.56 / $1,412.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,445.44 / $2,290.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $954.99 / $1,479.11
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $660.69 / $3,548.13
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $831.76 / $1,258.93
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.59 / $691.83 / $8,128.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $977.24 / $3,388.44
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $602.56
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $870.96 / $1,479.11
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $5,754.40 / $5,754.40
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $1,318.26 / $3,235.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,380.38 / $2,187.76
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $3,235.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,884.03 / $4,466.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $616.60 / $1,659.59