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Minnesota rates for HCPCS V2115

Lenticular (Myodisc), Per Lens, Sngle Vision

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$88.74 / $88.74 / $88.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$40.47 / $77.73 / $89.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$105.94 / $105.94 / $105.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.35 / $105.94 / $105.94
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.83 / $302.60 / $380.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.23 / $135.30 / $156.21
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$241.83 / $299.60 / $628.55
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55.00 / $123.00 / $123.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60.69 / $90.18 / $105.94
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.53 / $42.21 / $84.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.53 / $42.21 / $88.00