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Montana rates for HCPCS V2521

Contact lens, hydrophilic, toric, or prism ballast, per lens

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $177.83 / $245.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $104.71 / $104.71
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$186.21 / $234.42 / $295.12
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $234.42 / $295.12
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.04 / $223.87 / $245.47
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $100.00 / $107.15
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.72 / $109.65 / $154.88