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Wisconsin rates for HCPCS V2313

Spherocylinder, trifocal, 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
$104.71 / $104.71 / $104.71
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $100.00 / $125.89
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $120.23 / $144.54
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $398.11 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $181.97 / $245.47
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.20 / $104.71 / $125.89
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $154.88 / $181.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $125.89 / $269.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $60.26 / $117.49
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $50.12 / $70.79
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $194.98 / $363.08
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$257.04 / $257.04 / $758.58
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $190.55 / $870.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $60.26 / $95.50