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Wisconsin rates for HCPCS 67121

Rmvl Implt Matrl Posterior Segment Intraocular

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,349.89 / $3,119.00 / $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
$2,384.36 / $2,786.32 / $4,494.22
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$867.36 / $1,245.43 / $1,769.14
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$924.00 / $4,240.00 / $11,598.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$867.36 / $1,245.43 / $1,837.65
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,605.00 / $2,118.60 / $3,162.65
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,373.38 / $7,373.38 / $7,373.38
Quartz
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$652.85 / $652.85 / $652.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,241.00 / $9,837.00 / $12,062.00