go back

Balloon Opening of a Blocked Tear Duct

West Virginia rates for HCPCS 68816

Opens a blocked tear duct by passing a fine probe down the drainage channel from the eyelid towards the nose, then inflating a small balloon inside it to stretch the passage open. It treats a constantly watery, sticky eye caused by tears that cannot drain away.

Rates data updated October 2026.

How much does Balloon Opening of a Blocked Tear Duct cost?

$2,004

Typical total for the visit. In West Virginia, October 2026.

Insurers have agreed to pay about $2,004 for this procedure. That total is two separate charges: $525 to the doctor who performs it, and $1,479 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$525$234 to $851
Facility feeThe hospital or surgery center$1,479$1,259 to $2,455

How much rates vary

Facilitymedian $1,479 · 10th to 90th $234 to $2,951Professionalmedian $525 · 10th to 90th $155 to $1,230
$50$100$200$500$1K$2K$5Kfacility $1,479professional $525

Distribution of negotiated rates across all payers (price axis is log-scale). Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
None
Typical Low
$1,412.54
Median
$1,412.54
Typical High
$1,621.81
Aetna
Setting
Professional
Modifier
None
Typical Low
$154.88
Median
$194.98
Typical High
$831.76
CareSource
Setting
Professional
Modifier
None
Typical Low
$169.82
Median
$169.82
Typical High
$169.82
Cigna
Setting
Facility
Modifier
None
Typical Low
$34.67
Median
$234.42
Typical High
$2,951.21
Cigna
Setting
Professional
Modifier
None
Typical Low
$234.42
Median
$645.65
Typical High
$1,548.82
United
Setting
Facility
Modifier
None
Typical Low
$1,202.26
Median
$1,479.11
Typical High
$6,606.93
United
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$512.86
Typical High
$1,047.13
2 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$117.49
Median
$147.91
Typical High
$630.96
Aetna
Setting
Professional
Modifier
78 · Unplanned return to OR
Typical Low
$109.65
Median
$138.04
Typical High
$588.84

Where West Virginia sits

The same service costs 3.5 times more in Colorado than in Montana. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Physician feeFacility fee

West Virginia· 40th of 51

$2,004

$525 physician + $1,479 facility

CO $4,667MT $1,347

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.