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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
$19.95 / $37.15 / $44.67
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.89 / $58.88 / $104.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$41.69 / $41.69 / $41.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.88 / $21.88 / $21.88
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.86 / $57.54 / $70.79
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$39.81 / $39.81 / $54.95
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.70 / $39.81 / $61.66
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $36.31
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$37.15 / $46.77 / $58.88
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.31 / $46.77 / $58.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$22.39 / $29.51 / $37.15