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Wisconsin rates for HCPCS 66174

Trluml Dilat Aqueous O/F Can Wo Retention Dev/St

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$934.52 / $1,287.83 / $14,482.00
Aetna
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$700.89 / $700.89 / $1,721.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$581.21 / $934.52 / $2,295.19
Aetna
Facility/Professional
Professional
Modifier
55
Low / Median / High Price
$1,402.11 / $1,402.11 / $1,402.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,948.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$903.54 / $1,374.34 / $4,318.21
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,659.86 / $1,939.68 / $3,128.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$866.58 / $1,516.35 / $2,257.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.41 / $934.52 / $1,846.99
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$686.84 / $7,301.00 / $15,702.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.80 / $1,851.08 / $4,714.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.75 / $321.65 / $991.45
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$597.41 / $934.52 / $1,846.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,112.40 / $1,468.37 / $2,191.98
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,879.05 / $11,879.05 / $11,879.05
Quartz
Facility/Professional
Facility
Modifier
54
Low / Median / High Price
$7,881.75 / $7,881.75 / $7,881.75
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,032.82 / $4,595.00 / $4,714.27
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,636.13 / $5,412.70 / $6,067.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$876.00 / $1,851.08 / $4,027.52