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Maine 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
$20.38 / $25.94 / $38.74
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.33 / $106.33 / $106.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$58.87 / $60.28 / $60.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.86 / $36.86 / $36.86
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $25.94 / $38.74
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $22.55 / $51.87