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Illinois rates for HCPCS V2104

Spherocylinder Single Vision 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
$20.38 / $36.43 / $43.03
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.74 / $72.63 / $72.63
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $56.81
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.04 / $48.42 / $82.31
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.84 / $67.79 / $2,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $23.08 / $32.00