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

Ohio 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 $41 · 10th–90th $41$590%20%40%90th$41Professionalmedian $36 · 10th–90th $20$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
$19.95
Median
$36.31
Typical High
$43.65
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$20.89
Median
$26.30
Typical High
$61.66
Aultcare
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$48.98
Typical High
$48.98
CareSource
Setting
Facility
Modifier
Global
Typical Low
$40.74
Median
$40.74
Typical High
$58.88
CareSource
Setting
Professional
Modifier
Global
Typical Low
$58.88
Median
$58.88
Typical High
$61.66
Cigna
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$22.39
Typical High
$22.39
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$22.39
Median
$22.39
Typical High
$22.39
Molina
Setting
Professional
Modifier
Global
Typical Low
$29.51
Median
$46.77
Typical High
$60.26
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$41.69
Median
$50.12
Typical High
$83.18
United
Setting
Professional
Modifier
Global
Typical Low
$15.14
Median
$22.39
Typical High
$34.67