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Montana rates for HCPCS V2105

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.28 / $48.40 / $48.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.63 / $23.63
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.96 / $35.22 / $49.23
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $51.91 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.19 / $24.56 / $35.22