go back

Pennsylvania rates for HCPCS V2522

Contact Lens Hydrophillic Bifocal Per Lens (Special Coverage Instructions Apply. See Cim: 45-7 65-1)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.57 / $169.63 / $200.86
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.39 / $229.39 / $229.39
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.75 / $289.75 / $289.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.80 / $101.80 / $101.80
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$311.06 / $382.88 / $613.63
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.57 / $170.85 / $209.94
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$289.75 / $289.75 / $289.75
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.80 / $101.80 / $101.80
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$164.01 / $164.01 / $218.33
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.01 / $218.33 / $269.14
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.43 / $114.44 / $190.73