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Pennsylvania 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
$21.63 / $42.75 / $57.47
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.64 / $65.64 / $65.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.87 / $64.87 / $64.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.63 / $23.63
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.20 / $88.88 / $142.44
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.45 / $43.10 / $57.47
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$64.87 / $64.87 / $64.87
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.63 / $23.63
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.92 / $46.92 / $62.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$46.92 / $62.47 / $62.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.56 / $32.74 / $53.86