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Utah 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
$70.19 / $145.19 / $193.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.60 / $104.60 / $104.60
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $60.00 / $215.48
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.13 / $108.72 / $163.78