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Pennsylvania 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 / $176.32 / $225.10
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.06 / $257.06 / $257.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.73 / $283.73 / $283.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $104.60
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$319.63 / $393.43 / $630.54
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$192.80 / $192.80 / $192.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.62 / $181.57 / $238.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$283.73 / $283.73 / $283.73
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $104.60
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$183.81 / $183.81 / $244.68
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$183.81 / $244.68 / $276.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.72 / $128.25 / $213.75