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Wisconsin rates for HCPCS 67042

Vitrectomy, mechanical, pars plana approach; with removal of internal limiting membrane of retina (eg, for repair of macular hole, diabetic macular edema), includes, if performed, intraocular tamponade (ie, air, gas or silicone oil)

Facilitymedian $10,471 · 10th–90th $5,495$16,9820%10%10th90th$10,471Professionalmedian $1,698 · 10th–90th $1,096$5,1290%10%10th90th$1,698$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $9,549.93 / $15,848.93
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,445.44 / $3,548.13
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $2,187.76 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,548.13 / $5,623.41
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $4,073.80 / $5,623.41
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,258.93 / $4,677.35 / $9,549.93
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,818.38 / $3,388.44
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,258.93 / $7,585.78 / $15,848.93
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $2,238.72 / $11,220.18
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $85.11
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $9,332.54 / $15,848.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $3,388.44 / $5,495.41
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,047.13 / $2,238.72 / $3,467.37
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,128.31 / $11,748.98 / $11,748.98
Quartz
Facility/Professional
Facility
Modifier
AS
Typical Low / Median / Typical High
$812.83 / $1,174.90 / $1,174.90
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $6,025.60 / $11,220.18
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,370.32 / $5,370.32 / $5,370.32
Security Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $6,606.93 / $6,606.93
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $10,964.78 / $10,964.78
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $12,022.64 / $14,454.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$95.50 / $2,290.87 / $8,511.38