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Wisconsin rates for HCPCS V2100

Sphere Single Vision Plano To Plus Or Minus 4.00 Per Lens

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.74 / $46.74 / $46.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.42 / $42.49 / $47.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.89 / $51.89 / $63.61
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.41 / $119.41 / $119.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.59 / $174.80 / $198.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.57 / $81.09 / $105.60
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.76 / $46.74 / $55.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.38 / $49.08 / $58.59
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.55 / $27.84 / $51.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.76 / $46.74 / $55.80
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.80 / $83.70 / $136.33
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$113.27 / $113.27 / $250.01
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.57 / $245.21 / $312.20
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.80 / $55.80 / $55.80
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.94 / $16.88 / $55.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.37 / $26.68 / $44.34