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Wisconsin rates for HCPCS 66170

Fstlj Sclera Glaucoma Trabeculect Ab Externo

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,637.54 / $4,018.14 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,901.61 / $3,390.76 / $5,469.17
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,002.03 / $1,501.79 / $2,127.06
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.44 / $4,614.00 / $8,384.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,002.03 / $1,501.79 / $2,234.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,947.00 / $2,570.04 / $3,648.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,673.34 / $7,673.34 / $7,673.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00