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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
$20.90 / $43.71 / $62.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $31.15 / $31.15
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.93 / $60.00 / $67.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.35 / $32.38 / $48.77