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Wisconsin rates for HCPCS 67145

Prophylaxis of retinal detachment (eg, retinal break, lattice degeneration) without drainage; photocoagulation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$363.08 / $1,479.11 / $2,041.74
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$6,760.83 / $6,760.83 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $457.09 / $1,230.27
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$660.69 / $1,659.59 / $2,754.23
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $512.86 / $1,862.09
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$524.81 / $776.25 / $2,818.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $269.15 / $269.15
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $758.58 / $1,202.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $575.44 / $1,202.26
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $645.65 / $3,981.07
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $575.44 / $724.44
DeanCare
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$645.65 / $870.96 / $1,071.52
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $676.08 / $3,981.07
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $1,023.29 / $2,951.21
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $691.83
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $562.34 / $851.14
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $3,890.45 / $3,890.45
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $1,258.93 / $2,951.21
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $2,398.83 / $3,388.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,041.74 / $2,818.38 / $4,677.35
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $741.31 / $2,137.96