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Wisconsin rates for HCPCS 66172

Fistulization of sclera for glaucoma; trabeculectomy ab externo with scarring from previous ocular surgery or trauma (includes injection of antifibrotic agents)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,454.71 / $14,454.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,897.79 / $7,585.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $3,715.35 / $5,888.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $3,801.89 / $6,918.31
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $4,466.84 / $8,317.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $2,454.71 / $3,715.35
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $8,128.31 / $8,128.31
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11