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Nebraska 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
Facility
Modifier
Low / Median / High Price
$209.11 / $209.11 / $209.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.88 / $209.11 / $243.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $336.75 / $420.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$209.11 / $261.39 / $469.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $128.94 / $202.29
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.00 / $284.32 / $504.02
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.61 / $232.85 / $585.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.96 / $121.90 / $128.94