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Alaska rates for HCPCS V2109

Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.58 / $53.91 / $73.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.56 / $28.56 / $28.56
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$53.02 / $73.70 / $88.44
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $73.56 / $77.43
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$42.48 / $73.70 / $88.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.56 / $77.38 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.45 / $38.63 / $143.61