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Wisconsin rates for HCPCS 67027

Impltj Intravitreal Drug Dlvr Sys Rmvl Vts

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,266.48 / $3,104.54 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,466.00 / $15,738.00 / $23,778.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,234.78 / $2,611.51 / $4,212.28
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.20 / $1,200.01 / $1,660.77
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$879.28 / $5,266.00 / $15,743.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$774.20 / $1,200.01 / $1,722.00
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,504.20 / $1,985.54 / $2,964.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,674.70 / $10,674.70 / $10,674.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,217.00 / $11,608.00 / $13,980.00