HCPCS V2109

Spherocylinder, single vision, plus or minus 4.25 to plus or minus 7.00d sphere, 4.25 to 6.00d cylinder, per lens

Current code21 hospitals with prices

Description from CMS's HCPCS Level II code file.

What Washington hospitals publish for this code

Commercial insurance: Rate negotiated with a private insurer or employer plan, including exchange and public-option plans.

Prices for HCPCS V2109 by hospital
HospitalCommercial insurance rates (lowest – highest)Cash priceList price (before discounts)
Capital Medical CenterOlympiaFile dated 2026-08-27$58.03 – $45016 plans——
Deaconess Medical CenterSpokaneFile dated 2026-08-27$80.60 – $2809 plans——
Kadlec Regional Medical CenterRichlandFile dated 2026-04-01$102 – $1895 plans——
Mary Bridge Children's HospitalTacomaFile dated 2026-08-27$58.03 – $4947 plans——
MultiCare Auburn Medical CenterAuburnFile dated 2026-08-27$56.42 – $29117 plans——
MultiCare Covington Medical CenterCovingtonFile dated 2026-08-27$56.42 – $29117 plans——
MultiCare Good Samaritan HospitalPuyallupFile dated 2026-08-27$65.47 – $29112 plans——
MultiCare Valley HospitalSpokane ValleyFile dated 2026-08-27$64.48 – $28010 plans——
Overlake Hospital Medical Center & ClinicsBellevueFile dated 2026-04-01$61.77 – $18510 plans——
Prov Sacred HRT Med Ctr & Childs Hosp.SpokaneFile dated 2026-04-01$104 – $2239 plans——
Providence Centralia HospitalCentraliaFile dated 2026-04-01$114 – $2525 plans——
Providence Regional Medical Center EverettEverettFile dated 2026-04-01$80.82 – $1567 plans——
Providence St Peter HospitalOlympiaFile dated 2026-04-01$57.25 – $2208 plans——
Swedish Edmonds HospitalEdmondsFile dated 2026-04-01$101 – $2477 plans——
Swedish IssaquahIssaquahFile dated 2026-04-01$101 – $1507 plans——
Swedish Medical CenterSeattleFile dated 2026-04-01$101 – $2419 plans——
Swedish Medical Center / Cherry HillSeattleFile dated 2026-04-01$101 – $2419 plans——
Tacoma General Allenmore HospitalTacomaFile dated 2026-08-27$56.42 – $29117 plans——
Virginia Mason Medical CenterSeattle$64.48 – $2347 plans——
Wellfound Behavioral Health HospitalTacomaFile dated 2026-08-27$1701 plan——
Yakima Valley MemorialYakimaFile dated 2026-08-27$58.03 – $17513 plans——

Lowest and highest amounts each hospital lists for this code as an outpatient, including lines it lists for both settings or without saying which. A doctor’s fee is shown separately when the hospital lists one with the code. “At least” means plans were counted in more than one group and some may be the same plan. This is one line of a bill; most care brings several.

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
$67.35 (fee)