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Montana rates for HCPCS V2501

Contact lens, PMMA, toric or prism ballast, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.32 / $122.56 / $130.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.33 / $71.33 / $71.33
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$99.82 / $129.97 / $181.59
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.33 / $130.12 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.00 / $74.14 / $123.56