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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
Facility
Modifier
Low / Median / High Price
$38.90 / $38.90 / $38.90
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $36.31 / $45.71
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$38.90 / $72.44 / $72.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $60.26
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.48 / $48.98 / $66.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $22.91 / $32.36