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Idaho 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
$18.67 / $42.91 / $46.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$31.51 / $43.90 / $52.55
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.22 / $49.92 / $52.55
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.53 / $81.45 / $102.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.85 / $21.46 / $22.55