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Texas rates for HCPCS V2104

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens

Facilitymedian $43 · 10th–90th $32–$740%10%10th90th$43Professionalmedian $37 · 10th–90th $20–$450%20%10th90th$37$10.0$20.0$50.0$100.0$200.0$500.0$1.0K

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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $38.02 / $44.67
Baylor Scott & White
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$28.84 / $39.81 / $52.48
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $79.43 / $79.43
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $22.39 / $22.39
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$295.12 / $457.09 / $457.09
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $41.69 / $52.48
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $39.81 / $50.12
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $24.55 / $24.55
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$19.95 / $52.48 / $117.49
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.90 / $41.69 / $52.48
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $22.39 / $22.39
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$15.14 / $15.14 / $41.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$18.62 / $27.54 / $32.36
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$52.48 / $52.48 / $52.48