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Vermont 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 / $28.73 / $39.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.27 / $40.27 / $45.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.55 / $30.07 / $94.26