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Wisconsin rates for HCPCS 65290

Repair of wound, extraocular muscle, tendon and/or Tenon's capsule

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,000.00 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $537.03 / $851.14
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,011.87 / $7,943.28 / $12,589.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $954.99 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,513.56 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,318.26 / $1,819.70
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $1,819.70 / $5,754.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,202.26 / $1,445.44
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$537.03 / $4,265.80 / $11,481.54
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $977.24 / $3,630.78
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $977.24 / $1,513.56
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $8,912.51 / $8,912.51
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $2,398.83 / $3,548.13
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,290.87 / $2,290.87 / $2,290.87
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,128.61 / $5,128.61 / $5,128.61
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,905.46 / $4,786.30 / $4,786.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,606.93 / $10,232.93 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $812.83 / $2,089.30