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Single Vision Spherocylinder, Plano to +/-4.00d/2.12-4.00d

Massachusetts rates for HCPCS V2104

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

Rates data updated July 2026.

Facilitymedian $47 · 10th–90th $39$660%10%20%10th90th$47Professionalmedian $36 · 10th–90th $19$460%20%10th90th$36$10.0$20.0$50.0$100.0$200.0

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

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$18.62
Median
$36.31
Typical High
$45.71
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$43.65
Typical High
$66.07
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$30.20
Typical High
$77.62
Cigna
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$22.39
Typical High
$22.39
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$32.36
Median
$60.26
Typical High
$60.26
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$25.70
Median
$39.81
Typical High
$39.81
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$38.90
Median
$43.65
Typical High
$66.07
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$30.20
Typical High
$77.62
United
Setting
Professional
Modifier
Global
Typical Low
$17.78
Median
$30.20
Typical High
$39.81