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Missouri rates for HCPCS 92004

Ophthalmological services: medical examination and evaluation with initiation of diagnostic and treatment program; comprehensive, new patient, 1 or more visits

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.00 / $72.00 / $114.01
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.23 / $119.73 / $190.00
Aetna
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$153.00 / $156.06 / $288.14
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.07 / $134.59 / $176.96
Ambetter
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$98.50 / $125.17 / $229.26
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.15 / $110.00 / $173.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.62 / $138.93 / $266.27
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$72.00 / $131.16 / $256.87
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.84 / $163.35 / $944.28
Medica
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$165.00 / $179.52 / $181.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.97 / $129.76 / $190.83