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Hawaii 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
$149.44 / $206.02 / $225.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $247.75
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.00 / $141.36 / $141.36
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$315.32 / $315.32 / $315.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.13 / $138.94 / $280.92
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.65 / $197.22 / $214.38