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Michigan 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
$19.95 / $36.31 / $44.67
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.71 / $48.98 / $56.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $70.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $38.02 / $45.71
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $22.39 / $34.67