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California rates for HCPCS V2104

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

Facilitymedian $49 · 10th–90th $29$910%20%10th90th$49Professionalmedian $37 · 10th–90th $18$520%20%10th90th$37$10.0$20.0$50.0$100.0$200.0$500.0

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.20 / $37.15 / $46.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$91.20 / $91.20 / $91.20
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.89 / $41.69 / $61.66
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$53.70 / $123.03 / $177.83
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $22.39 / $22.39
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $25.12 / $57.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$43.65 / $43.65 / $67.61
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $457.09 / $457.09
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$58.88 / $58.88 / $58.88
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$28.84 / $44.67 / $53.70
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $22.39 / $72.44
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$89.13 / $89.13 / $89.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$26.92 / $26.92 / $26.92
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$17.78 / $22.91 / $48.98