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Utah rates for HCPCS V2104

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

Professionalmedian $38 · 10th–90th $18–$480%20%10th90th$38$10.0$20.0$50.0

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
$18.20 / $38.02 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $22.39 / $22.39
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $41.69 / $56.23
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$48.98 / $57.54 / $57.54
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $58.88 / $87.10
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $22.39 / $34.67