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Oregon 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
$18.67 / $40.56 / $43.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.55 / $96.14 / $114.91
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.85 / $44.80 / $79.34
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.46 / $49.92 / $55.18
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.50 / $51.32 / $57.61
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$29.85 / $45.52 / $79.34
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $50.02 / $71.75
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.02 / $22.55 / $43.03