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Montana rates for HCPCS V2523

Contact Lens Hydrophilic Extended Wear Per Lens (Special Coverage Instructions Apply. See Cim: 45-7 65-1)

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.69 / $152.22 / $193.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.76 / $86.76 / $86.76
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$102.65 / $131.99 / $180.74
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.76 / $161.61 / $10,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$81.48 / $90.17 / $129.36