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Washington 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 / $53.91 / $66.45
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$103.92 / $317.68 / $10,000.00
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.07 / $368.02 / $561.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.56 / $28.56 / $28.56
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$41.54 / $69.95 / $170.62
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.02 / $68.28 / $132.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.00 / $70.00 / $70.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$23.50 / $64.48 / $66.03
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.45 / $29.69 / $56.64