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Wisconsin rates for HCPCS V2113

Spherocylinder, single vision, plus or minus 7.25 to plus or minus 12.00d sphere, 4.25 to 6.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$74.13 / $74.13 / $74.13
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $70.79 / $79.43
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $85.11 / $102.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $281.84 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $128.82 / $169.82
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$63.10 / $74.13 / $89.13
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.28 / $107.15 / $190.55
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.57 / $89.13 / $181.97
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $42.66 / $81.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$83.18 / $134.90 / $223.87
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$181.97 / $181.97 / $398.11
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $134.90 / $478.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.51 / $39.81 / $66.07