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Montana 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
$53.65 / $53.91 / $54.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.56 / $28.56 / $28.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.79 / $43.09 / $59.51
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.56 / $57.82 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.83 / $29.69 / $49.48