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Utah 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
$68.31 / $145.43 / $200.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.80 / $101.80 / $101.80
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $172.50 / $209.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.84 / $105.81 / $159.38