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New Hampshire 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 / $103.21 / $190.83
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.28 / $112.91 / $134.08
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.87 / $104.20 / $184.42