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Texas rates for HCPCS V2105

Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 4.25 to 6.00d cylinder, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.60 / $42.07 / $48.40
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.81 / $41.47 / $55.63
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.63 / $23.63
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $116.93 / $257.91
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.07 / $315.07 / $492.30
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.75 / $43.29 / $50.57
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.98 / $56.33 / $56.33
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$48.04 / $50.57 / $54.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$33.79 / $43.10 / $50.57
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.63 / $23.63 / $56.43
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$20.47 / $30.27 / $35.22
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$50.57 / $50.57 / $68.27