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Wisconsin rates for HCPCS 67904

Rpr Blepharoptosis Levator Rescj/Advmnt Xtrnl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$888.99 / $1,522.31 / $8,243.00
Aetna
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$0.95 / $5,258.50 / $12,364.50
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$525.21 / $776.46 / $1,815.02
Aetna
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$733.32 / $841.15 / $4,506.14
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
$648.63 / $1,147.81 / $3,024.17
Anthem BCBS
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,081.06 / $1,755.48 / $4,536.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,980.66 / $2,314.56 / $3,733.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.29 / $1,496.84 / $3,615.49
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.77 / $888.99 / $1,516.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.77 / $1,164.97 / $8,384.00
Medica
Facility/Professional
Facility
Modifier
50
Low / Median / High Price
$4,056.75 / $4,056.75 / $4,056.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$723.57 / $1,462.48 / $7,208.00
Medica
Facility/Professional
Professional
Modifier
50
Low / Median / High Price
$1,804.37 / $1,804.37 / $1,988.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$62.75 / $410.55 / $1,226.41
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$654.77 / $906.89 / $1,693.50
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.50 / $1,729.84 / $2,490.37
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,169.04 / $4,169.04 / $4,169.04
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$934.39 / $2,892.70 / $7,208.00
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,657.46 / $5,765.53 / $7,216.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,918.00 / $6,477.00 / $8,384.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$737.23 / $1,491.73 / $3,232.16