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Montana 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
$42.91 / $43.35 / $45.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.56 / $41.21 / $57.61
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $46.02 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $22.55 / $32.35