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Wisconsin rates for HCPCS V2109

Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.07 / $66.07 / $66.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.92 / $52.48 / $66.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $75.86 / $91.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $251.19 / $346.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $114.82 / $154.88
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$52.48 / $66.07 / $79.43
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $97.72 / $141.25
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.88 / $75.86 / $162.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $38.02 / $74.13
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.07 / $109.65 / $177.83
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $162.18 / $338.84
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $120.23 / $371.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $35.48 / $60.26