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Massachusetts 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 / $33.65 / $43.88
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.11 / $44.15 / $66.22
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.23 / $34.90 / $274.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $24.03
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.86 / $36.86 / $36.86
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $22.55 / $289.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $22.55 / $44.15