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Indiana 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
$32.27 / $36.86 / $42.98
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.79 / $20.79 / $30.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.42 / $62.95 / $67.79
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.42 / $53.26 / $60.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $55.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.04 / $22.55 / $30.35