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Washington rates for HCPCS V2104

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

Facilitymedian $52 · 10th–90th $32–$1200%10%20%10th90th$52Professionalmedian $37 · 10th–90th $18–$590%10%20%10th90th$37$10.0$50.0$200.0$1.0K$5.0K

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
$18.20 / $36.31 / $42.66
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$22.39 / $22.39 / $22.39
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$31.62 / $52.48 / $128.82
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$31.62 / $51.29 / $102.33
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$51.29 / $52.48 / $56.23
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,000.00 / $10,000.00 / $10,000.00
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$10,000.00 / $10,000.00 / $10,000.00
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$53.70 / $53.70 / $53.70
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$20.42 / $22.39 / $42.66
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$45.71 / $45.71 / $60.26