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New Hampshire rates for HCPCS V2623

Prosthetic eye, plastic, custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$451.79 / $451.79 / $542.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.79 / $721.60 / $943.39
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,135.43 / $1,135.43 / $1,345.94
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,100.00 / $2,310.00 / $2,310.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,396.46 / $1,396.46 / $1,396.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.14 / $517.14 / $517.14
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$925.88 / $925.88 / $2,857.73
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$377.64 / $566.45 / $672.60
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$755.27 / $830.80 / $1,057.38