go back

Single Vision Spherocylinder, Plano to +/-4.00d/0.12-2.00d

Wisconsin rates for HCPCS V2103

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 0.12 to 2.00d cylinder, per lens

Rates data updated July 2026.

Facilitymedian $47 · 10th–90th $35$1510%20%10th90th$47Professionalmedian $36 · 10th–90th $17$790%10%10th90th$36$10.0$20.0$50.0$100.0$200.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$38.90
Typical High
$38.90
Aetna
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$33.88
Typical High
$41.69
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$44.67
Typical High
$52.48
Cigna
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$151.36
Typical High
$223.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$67.61
Typical High
$91.20
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$41.69
Typical High
$46.77
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$42.66
Median
$79.43
Typical High
$107.15
Medica
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$42.66
Typical High
$72.44
Medica
Setting
Professional
Modifier
Global
Typical Low
$15.85
Median
$22.39
Typical High
$43.65
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$50.12
Typical High
$70.79
Network Health
Setting
Professional
Modifier
Global
Typical Low
$35.48
Median
$46.77
Typical High
$72.44
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$41.69
Typical High
$46.77
Quartz
Setting
Professional
Modifier
Global
Typical Low
$44.67
Median
$72.44
Typical High
$123.03
Quartz
Setting
Facility
Modifier
Global
Typical Low
$97.72
Median
$97.72
Typical High
$223.87
Quartz
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$70.79
Typical High
$269.15
Security Health
Setting
Professional
Modifier
Global
Typical Low
$15.85
Median
$16.98
Typical High
$18.62
United
Setting
Professional
Modifier
Global
Typical Low
$16.98
Median
$70.79
Typical High
$100.00