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California rates for HCPCS V2204

Spherocylinder, bifocal, 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
$26.80 / $53.63 / $67.25
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.07 / $140.07 / $140.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.60 / $71.81 / $86.53
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $196.08 / $286.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $31.15 / $31.15
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.77 / $40.00 / $85.34
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.00 / $69.81 / $96.98
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.49 / $135.18 / $368.51
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.81 / $407.81 / $637.20
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.27 / $77.58 / $77.58
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $31.15 / $90.91
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.41 / $146.41 / $146.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.93 / $32.38 / $108.78