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Ohio 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
$20.38 / $36.15 / $45.24
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.38 / $22.33 / $60.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.42 / $58.10 / $72.63
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.26 / $62.95 / $116.21
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$15.04 / $22.55 / $29.42