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Wisconsin rates for HCPCS 67250

Scleral reinforcement (separate procedure); without graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,380.38 / $1,862.09 / $14,454.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $1,737.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $4,786.30 / $7,585.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,778.28 / $4,365.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,398.83 / $2,818.38 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $2,398.83 / $4,466.84
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $3,162.28 / $5,754.40
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.59 / $2,238.72 / $2,511.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $4,073.80 / $8,317.64
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,659.59 / $6,760.83
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $85.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,862.09 / $2,884.03
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,981.07 / $6,025.60 / $6,025.60
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $4,073.80 / $6,456.54
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,365.16
Security Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $3,235.94 / $3,235.94
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,162.28 / $8,912.51 / $8,912.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $7,413.10 / $9,120.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,412.54 / $3,548.13