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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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.56 / $30.12 / $43.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.06 / $51.21 / $56.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $22.55 / $37.59