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Pennsylvania 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
$28.00 / $53.48 / $75.77
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.53 / $86.53 / $86.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.58 / $83.58 / $83.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $31.15 / $31.15
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.46 / $115.04 / $184.36
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.00 / $54.11 / $75.77
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.00 / $35.00 / $40.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.58 / $83.58 / $83.58
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $31.15 / $31.15
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.86 / $61.86 / $82.36
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.86 / $82.36 / $82.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.38 / $43.17 / $71.01