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Pennsylvania rates for HCPCS V2115

Lenticular (myodisc), per lens, single vision

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.97 / $68.27 / $85.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.26 / $96.26 / $96.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.44 / $115.44 / $115.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.61 / $42.61 / $42.61
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.85 / $124.13 / $198.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.97 / $71.52 / $88.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$25.00 / $25.00 / $25.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.44 / $115.44 / $115.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$42.61 / $42.61 / $42.61
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.84 / $68.84 / $91.62
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.84 / $91.62 / $100.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$43.42 / $48.02 / $80.04