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Virginia 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
$20.21 / $36.45 / $45.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.79 / $58.87 / $58.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.32 / $41.32 / $41.32
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$58.59 / $58.59 / $58.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $21.70
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.13 / $56.03 / $70.19
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.12 / $38.88 / $65.61
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.31 / $80.00 / $138.24
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$38.61 / $47.61 / $73.70
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.44 / $47.61 / $73.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.55 / $29.42 / $35.47