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Pennsylvania 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
$25.26 / $52.11 / $69.47
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.34 / $79.34 / $79.34
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.06 / $78.06 / $78.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.56 / $28.56 / $28.56
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.34 / $103.81 / $166.37
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.13 / $52.65 / $69.47
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.40 / $48.40 / $48.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$78.06 / $78.06 / $78.06
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.56 / $28.56 / $28.56
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.73 / $56.73 / $75.52
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.73 / $75.52 / $75.52
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.69 / $39.58 / $65.97