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Utah 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 / $54.95 / $61.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.90 / $30.90 / $30.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.67 / $50.12 / $63.10
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.66 / $69.18 / $77.62
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.10 / $69.18 / $69.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.12 / $32.36 / $48.98