go back

Utah 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
$15.85 / $33.75 / $48.90
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.63 / $23.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.94 / $43.78 / $48.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.23 / $24.56 / $36.99