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New Hampshire 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
$17.98 / $20.61 / $38.74
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $22.55 / $27.19
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.59 / $36.71 / $57.94