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Pennsylvania 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
$74.63 / $148.41 / $198.51
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$226.70 / $226.70 / $226.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.31 / $238.31 / $238.31
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.76 / $86.76 / $86.76
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$247.79 / $305.00 / $488.81
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.63 / $148.88 / $198.51
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$238.31 / $238.31 / $238.31
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$86.76 / $86.76 / $86.76
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.08 / $162.08 / $215.78
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.08 / $215.78 / $215.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.17 / $113.10 / $178.80