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Wisconsin rates for HCPCS 67025

Injection of vitreous substitute, pars plana or limbal approach (fluid-gas exchange), with or without aspiration (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.25 / $1,288.25 / $2,691.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $776.25 / $1,288.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,786.30 / $7,585.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,230.27 / $3,235.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,290.87 / $3,715.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,698.24 / $3,388.44
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,174.90 / $3,548.13
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,698.24 / $2,041.74
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $1,230.27 / $8,128.31
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,659.59 / $5,495.41
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $954.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,659.59 / $2,570.40
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $6,918.31 / $6,918.31
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $2,691.53 / $5,754.40
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $3,715.35 / $3,715.35
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,884.03 / $6,165.95 / $7,244.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,148.15 / $2,951.21