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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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.53 / $39.36 / $45.24
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.42 / $42.37 / $56.84
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $238.45
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$289.33 / $289.33 / $452.10
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.90 / $42.91 / $51.67
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.98 / $49.92 / $52.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$49.09 / $51.67 / $55.49
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$32.90 / $42.91 / $51.67
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $50.02
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$18.80 / $27.80 / $32.35
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.67 / $51.67 / $69.75