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Montana rates for HCPCS V2204

Spherocylinder Bifocal Plano To Plus Or Minus 4.00d Sphere 2.12 To 4.00d Cylinder Per Lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.58 / $62.20 / $62.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $31.15 / $31.15
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.85 / $48.96 / $68.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $66.04 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.93 / $32.38 / $53.96