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

New York 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 $71 · 10th–90th $35$1230%10%20%10th90th$71Professionalmedian $36 · 10th–90th $20$600%20%10th90th$36$1.0$5.0$20.0$100.0

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
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$123.03
Typical High
$123.03
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$20.42
Median
$25.70
Typical High
$107.15
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$46.77
Median
$50.12
Typical High
$50.12
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$50.12
Median
$50.12
Typical High
$50.12
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
$22.39
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$81.28
Typical High
$114.82
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$36.31
Typical High
$51.29
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$36.31
Median
$58.88
Typical High
$102.33
United
Setting
Professional
Modifier
Global
Typical Low
$19.95
Median
$37.15
Typical High
$81.28
Univera
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$34.67
Typical High
$34.67
Univera
Setting
Professional
Modifier
Global
Typical Low
$34.67
Median
$36.31
Typical High
$60.26