go back

North Carolina 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
$19.95 / $37.15 / $44.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $45.71 / $45.71
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $33.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.11 / $39.81 / $53.70
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$19.95 / $25.12 / $34.67
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.14 / $20.42 / $26.30
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $239.88
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$288.40 / $288.40 / $457.09