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Indiana 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
$46.27 / $50.70 / $58.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.60 / $28.60 / $44.34
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.59 / $86.57 / $93.23
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$66.59 / $73.25 / $83.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$31.15 / $31.15 / $77.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.58 / $31.62 / $42.54