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Michigan rates for HCPCS V2115

Lenticular (myodisc), per lens, single vision

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.04 / $77.73 / $86.93
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.94 / $105.94 / $105.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.64 / $111.24 / $143.02
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.61 / $42.61 / $153.75
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$63.22 / $75.16 / $98.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.67 / $12.27 / $19.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$34.68 / $48.87 / $67.26