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Utah 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
$15.85 / $34.67 / $40.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.50 / $19.50 / $19.50
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $37.15 / $50.12
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $50.12 / $52.48
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.77 / $51.29 / $51.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.85 / $20.42 / $30.90