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Michigan 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 / $190.83 / $235.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$290.57 / $290.57 / $290.57
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$276.04 / $305.10 / $392.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $420.94
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.88 / $206.14 / $246.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.00 / $208.15 / $325.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.13 / $136.44 / $224.15