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Ohio 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
Professional
Modifier
Low / Median / High Price
$78.84 / $135.21 / $225.00
Aetna
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$86.73 / $166.92 / $274.00
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$126.15 / $135.83 / $176.33
Ambetter
Facility/Professional
Professional
Modifier
25
Low / Median / High Price
$98.50 / $112.75 / $199.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.05 / $106.81 / $211.59
Aultcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.63 / $135.63 / $135.63
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$86.34 / $104.08 / $128.81
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.66 / $145.13 / $183.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$149.77 / $149.77 / $149.77
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.31 / $126.58 / $256.56
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.70 / $142.43 / $262.14
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.03 / $188.56 / $258.13
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.19 / $122.13 / $199.60