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Wisconsin rates for HCPCS 67120

Rmvl Implnt Matl Posterior Segment Extraocular

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$829.88 / $1,143.60 / $14,482.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,795.03 / $2,097.64 / $3,383.41
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$609.91 / $829.88 / $1,228.50
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$609.91 / $1,081.97 / $8,384.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$609.91 / $829.88 / $1,279.26
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,069.90 / $1,561.82 / $2,248.48
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,891.72 / $3,891.72 / $3,891.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00