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

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

Rates data updated July 2026.

Facilitymedian $40 · 10th–90th $32$560%20%40%10th90th$40Professionalmedian $39 · 10th–90th $20$460%20%10th90th$39$10.0$20.0$50.0$100.0$200.0$500.0

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

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$38.02
Typical High
$43.65
BCBS
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$45.71
Typical High
$45.71
Cigna
Setting
Facility
Modifier
Global
Typical Low
$70.79
Median
$70.79
Typical High
$70.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$22.39
Typical High
$33.88
Medcost
Setting
Facility
Modifier
Global
Typical Low
$31.62
Median
$39.81
Typical High
$53.70
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$25.12
Typical High
$34.67
United
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$20.42
Typical High
$28.84
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$245.47
Median
$245.47
Typical High
$245.47
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$457.09