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New Hampshire 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
$25.70 / $50.12 / $61.66
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.11 / $89.13 / $89.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $60.26 / $60.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.91 / $34.67 / $60.26
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.98 / $48.98 / $48.98