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South 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 / $42.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.88 / $45.71 / $57.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.12 / $39.81 / $48.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.78 / $21.38 / $27.54