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Pennsylvania rates for HCPCS V2103

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 0.12 to 2.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.85 / $33.02 / $47.66
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.42 / $54.42 / $54.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.53 / $53.53 / $53.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.59 / $19.59 / $19.59
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.86 / $73.68 / $118.09
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.75 / $36.75 / $36.75
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$16.86 / $33.64 / $47.66
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.53 / $53.53 / $53.53
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.59 / $19.59 / $19.59
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.92 / $38.92 / $51.81
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.92 / $51.81 / $51.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.84 / $27.16 / $44.68