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Maine rates for HCPCS V2623

Prosthetic eye, plastic, custom

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.41 / $651.41 / $721.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,009.85 / $1,308.35 / $2,425.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,100.00 / $2,100.00 / $2,310.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$723.64 / $723.64 / $723.64
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.91 / $517.14 / $517.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$925.88 / $925.88 / $925.88
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.79 / $651.41 / $651.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.13 / $566.45 / $1,302.67