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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

Facilitymedian $56 · 10th–90th $39–$710%50%10th90th$56Professionalmedian $40 · 10th–90th $32–$460%20%10th90th$40$10.0$20.0$50.0$100.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$33.11 / $39.81 / $44.67
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $22.39 / $22.39
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$44.67 / $56.23 / $70.79
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $56.23 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $42.66 / $58.88
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $45.71 / $100.00
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $22.39 / $33.88