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Utah 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
$23.99 / $50.12 / $60.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.84 / $28.84 / $28.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $43.65 / $58.88
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.70 / $58.88 / $72.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$54.95 / $60.26 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.44 / $29.51 / $44.67