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Montana rates for HCPCS V2103

Spherocylinder Single Vision Plano To Plus Or Minus 4.00d Sphere .12 To 2.00d Cylinder Per Lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.25 / $42.11 / $85.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.59 / $19.59 / $19.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.94 / $36.17 / $50.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.59 / $44.71 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.41 / $20.36 / $29.22