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Hawaii rates for HCPCS V2115

Lenticular (myodisc), per lens, single vision

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$47.15 / $84.29 / $89.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.61 / $42.61 / $146.80
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.83 / $186.83 / $186.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.68 / $52.03 / $166.44
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$111.18 / $116.85 / $127.02