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Maine 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
$98.27 / $129.85 / $176.32
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$532.33 / $532.33 / $532.33
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.76 / $290.57 / $290.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $104.60
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$184.56 / $184.56 / $184.56
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$98.27 / $129.85 / $176.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.28 / $112.91 / $259.68