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Wisconsin rates for HCPCS 66175

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,084.92 / $2,659.99 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,948.00 / $15,579.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,922.09 / $2,246.11 / $3,622.90
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.78 / $1,084.92 / $1,935.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$796.01 / $7,301.00 / $15,702.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$695.78 / $1,084.92 / $1,935.89
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.80 / $1,701.22 / $2,539.58
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$24,126.55 / $24,126.55 / $24,126.55
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00