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Hawaii rates for HCPCS V2104

Spherocylinder, single vision, 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
$31.00 / $45.40 / $51.65
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.70 / $21.70 / $57.16
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.73 / $72.73 / $72.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$17.66 / $31.88 / $64.79
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.28 / $45.49 / $49.45