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Wisconsin rates for HCPCS V2103

Spherocylinder Single Vision Plano To Plus Or Minus 4.00d Sphere .12 To 2.00d Cylinder Per Lens

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.34 / $39.34 / $39.34
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.86 / $38.00 / $85.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.68 / $43.68 / $53.54
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.52 / $100.52 / $100.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$126.16 / $147.41 / $167.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.59 / $67.97 / $88.90
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.29 / $39.92 / $46.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.19 / $41.31 / $49.32
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.97 / $23.43 / $43.77
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.29 / $39.34 / $46.97
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.14 / $70.45 / $118.80
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.35 / $100.00 / $217.85
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.59 / $206.42 / $261.22
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.97 / $46.97 / $46.97
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.94 / $16.88 / $46.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.94 / $22.45 / $37.40