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Louisiana 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 / $190.83 / $200.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$119.54 / $140.31 / $143.66
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $104.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.48 / $108.72 / $139.04