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California rates for HCPCS V2521

Contact Lens Hydrophilic Toric Or Prism Ballast Per Lens (Special Coverage Instructions Apply. See Cim: 45-7 65-1)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.99 / $175.55 / $225.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.45 / $393.45 / $393.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.73 / $241.19 / $290.57
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $550.85 / $804.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $104.60
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.00 / $136.15 / $239.71
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$159.00 / $196.13 / $272.39
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$333.07 / $589.86 / $1,154.65
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,394.74 / $1,394.74 / $2,179.28
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.05 / $217.92 / $231.73
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $255.38
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$411.32 / $411.32 / $411.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.52 / $108.72 / $217.93