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Wisconsin rates for HCPCS V2121

Lenticular lens, per lens, single

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$87.10 / $87.10 / $87.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $75.86 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $97.72 / $117.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$281.84 / $323.59 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $151.36 / $199.53
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $89.13 / $104.71
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.50 / $125.89 / $269.15
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$75.86 / $100.00 / $223.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $50.12 / $95.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.42 / $33.11 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $158.49 / $269.15
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.93 / $208.93 / $575.44
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $158.49 / $724.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $46.77 / $77.62