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Alaska rates for HCPCS V2104

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $39.81 / $47.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.74 / $46.77 / $48.98
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $48.98 / $52.48
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$36.31 / $45.71 / $54.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $22.39 / $79.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.96 / $23.99 / $100.00