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Alaska rates for HCPCS V2623

Prosthetic eye, plastic, custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.56 / $1,731.56 / $1,731.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.14 / $517.14 / $517.14
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.00 / $347.00 / $347.00
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,226.74 / $1,728.26 / $2,728.83
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.71 / $1,130.71 / $1,776.58
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,274.38 / $1,776.58 / $3,663.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.00 / $347.00 / $1,130.71
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.25 / $1,512.64 / $3,663.60
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$907.58 / $1,739.54 / $3,176.54