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Wisconsin rates for HCPCS V2631

Iris Supported Intraocular Lens (Special Coverage Instructions Apply. See Mcm: 2130)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$119.66 / $119.66 / $119.66
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.99 / $119.66 / $498.84
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.87 / $132.87 / $162.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.74 / $305.74 / $305.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$383.88 / $448.59 / $509.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.29 / $207.19 / $270.39
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.73 / $119.66 / $142.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.73 / $135.97 / $221.45
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.49 / $71.27 / $133.12
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.00 / $58.40 / $70.00
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.73 / $119.66 / $142.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.75 / $214.31 / $365.18
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.02 / $290.02 / $668.63
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.29 / $627.84 / $711.49
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.87 / $142.87 / $142.87
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.87 / $142.87 / $142.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.44 / $70.64 / $113.49