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Wisconsin rates for HCPCS V2104

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

Facilitymedian $49 · 10th–90th $38$1740%20%10th90th$49Professionalmedian $40 · 10th–90th $20$790%10%10th90th$40$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
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$39.81 / $39.81 / $39.81
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $37.15 / $45.71
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $45.71 / $53.70
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$128.82 / $151.36 / $208.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $70.79 / $93.33
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $40.74 / $48.98
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $81.28 / $107.15
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$35.48 / $44.67 / $75.86
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $22.91 / $44.67
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $50.12 / $70.79
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$36.31 / $48.98 / $75.86
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $74.13 / $134.90
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$97.72 / $97.72 / $239.88
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$21.88 / $218.78 / $288.40
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $64.57 / $100.00