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Ohio rates for HCPCS V2121

Lenticular lens, per lens, single

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.15 / $75.86 / $93.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$44.67 / $57.54 / $128.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $81.28 / $117.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $117.49 / $123.03
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.65 / $43.65 / $43.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $97.72 / $128.82
SummaCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.13 / $107.15 / $177.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $45.71 / $60.26