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Massachusetts rates for HCPCS V2623

Prosthetic eye, plastic, custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$721.60 / $721.60 / $721.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$444.87 / $721.60 / $943.39
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,025.00 / $3,059.63 / $6,823.42
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.80 / $874.43 / $1,153.17
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,205.14 / $1,466.19 / $1,888.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$743.50 / $946.63 / $1,672.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$796.00 / $796.00 / $796.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.14 / $517.14 / $1,312.13
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.43 / $4,618.00 / $9,239.00
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$925.88 / $925.88 / $972.17
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,528.81 / $6,823.42 / $6,823.42
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.13 / $566.45 / $1,546.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$432.29 / $566.45 / $1,391.03