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Wisconsin rates for HCPCS 67115

Release Encircling Material Posterior Segment

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$746.88 / $1,835.18 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$477.37 / $746.88 / $2,418.75
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,479.00 / $9,096.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$472.71 / $957.41 / $2,527.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,327.35 / $1,551.11 / $2,501.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$571.67 / $1,212.75 / $2,431.38
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.37 / $688.23 / $1,021.81
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$497.11 / $4,103.00 / $8,783.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.17 / $1,006.59 / $3,718.32
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.42 / $267.85 / $794.68
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$477.37 / $688.23 / $1,228.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$889.80 / $1,174.54 / $1,753.35
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,879.05 / $11,879.05 / $11,879.05
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$826.03 / $2,418.75 / $3,718.32
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,325.00 / $2,325.00 / $2,325.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,915.53 / $3,002.11 / $4,852.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,614.00 / $6,754.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$484.13 / $975.16 / $2,120.03