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Wisconsin rates for HCPCS 67912

Correction of lagophthalmos, with implantation of upper eyelid lid load (eg, gold weight)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.46 / $1,371.97 / $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
$2,423.11 / $2,831.60 / $4,567.27
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.73 / $953.19 / $1,646.36
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$531.11 / $1,290.10 / $8,384.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.73 / $887.88 / $1,704.64
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.41 / $1,703.00 / $2,952.92
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,399.78 / $3,399.78 / $3,399.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,614.00 / $6,477.00 / $8,384.00