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Wisconsin rates for HCPCS 67255

Scleral Reinforcement Spx W/Graft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.83 / $2,532.03 / $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
$1,832.88 / $2,141.86 / $3,454.75
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.90 / $1,010.29 / $1,410.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$757.72 / $4,103.00 / $8,783.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$659.90 / $1,010.29 / $2,197.08
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.40 / $1,618.85 / $2,416.62
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,879.05 / $11,879.05 / $11,879.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00