HCPCS V2104
Spherocylinder, single vision, plano to plus or minus 4.00d sphere, 2.12 to 4.00d cylinder, per lens
Current code21 hospitals with prices
What Washington hospitals publish for this code
Medicare Advantage: Rate for a private Medicare Advantage plan. Applies only to members of that plan.
| Hospital | Medicare Advantage rates (lowest – highest) | Cash price | List price (before discounts) |
|---|---|---|---|
| Capital Medical Center | $52.53 – $57.78 | — | — |
| Deaconess Medical Center | $52.53 – $57.78 | — | — |
| Kadlec Regional Medical Center | $53.60 – $64.32 | — | — |
| Mary Bridge Children's Hospital | $52.53 – $57.78 | — | — |
| MultiCare Auburn Medical Center | $52.53 – $57.78 | — | — |
| MultiCare Covington Medical Center | $52.53 – $57.78 | — | — |
| MultiCare Good Samaritan Hospital | $52.53 – $57.78 | — | — |
| MultiCare Valley Hospital | $54.10 – $57.78 | — | — |
| Overlake Hospital Medical Center & Clinics | $53.60 – $55.74 | — | — |
| Prov Sacred HRT Med Ctr & Childs Hosp. | $53.60 – $64.32 | — | — |
| Providence Centralia Hospital | $53.60 – $85.76 | — | — |
| Providence Regional Medical Center Everett | $53.60 – $58.96 | — | — |
| Providence St Peter Hospital | $53.60 – $85.76 | — | — |
| Swedish Edmonds Hospital | $53.60 – $64.32 | — | — |
| Swedish Issaquah | $53.60 – $64.32 | — | — |
| Swedish Medical Center | $53.60 – $64.32 | — | — |
| Swedish Medical Center / Cherry Hill | $53.60 – $64.32 | — | — |
| Tacoma General Allenmore Hospital | $52.53 – $57.78 | — | — |
| Virginia Mason Medical Center | $36.79 – $55.18 | — | — |
| Wellfound Behavioral Health Hospital | — | — | — |
| Yakima Valley Memorial | $52.53 – $58.83 | — | — |
Medicare (traditional) reference
Only for people on original Medicare. These are CMS’s 2026 amounts. They aren’t what private insurance or cash patients pay.
- Equipment fee, Washington
- $53.60 (fee)