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Wisconsin rates for HCPCS V2319

Trifocal seg width over 28 mm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.56 / $66.56 / $66.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.61 / $53.11 / $66.56
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.92 / $73.92 / $90.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.09 / $170.09 / $170.09
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.57 / $249.57 / $283.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.61 / $115.31 / $150.43
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.05 / $66.56 / $79.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.22 / $69.56 / $123.10
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.44 / $39.65 / $74.06
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.93 / $66.56 / $79.48
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.86 / $119.22 / $173.34
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.34 / $161.34 / $301.86
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.61 / $349.29 / $349.29
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.48 / $79.48 / $79.48
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.48 / $79.48 / $1,000,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.28 / $37.99 / $63.30