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Utah 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
$13.15 / $27.20 / $42.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.59 / $19.59 / $19.59
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.88 / $44.92 / $49.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.94 / $20.36 / $30.68