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Wisconsin rates for HCPCS 67250

Scleral Reinforcement Spx W/O Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,371.33 / $3,294.18 / $14,482.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$850.03 / $1,371.33 / $4,090.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,740.00 / $4,780.00 / $7,344.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.53 / $1,770.57 / $4,211.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,422.21 / $2,830.54 / $4,565.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,029.81 / $2,184.60 / $4,417.55
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.49 / $1,099.08 / $1,841.41
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.83 / $4,103.00 / $8,384.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$821.49 / $1,675.08 / $6,736.72
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.28 / $503.94 / $1,504.31
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.49 / $1,099.08 / $1,999.99
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,595.40 / $2,105.92 / $3,143.74
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,363.12 / $6,363.12 / $6,363.12
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.81 / $4,090.00 / $6,736.72
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,323.10 / $4,323.10 / $4,323.10
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,991.31 / $5,582.14 / $8,817.41
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,614.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$860.09 / $1,616.58 / $3,584.89