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Pennsylvania rates for HCPCS V2623

Prosthetic Eye Plastic Custom (Special Coverage Instructions Apply. See Mcm: 2133)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$839.62 / $943.39 / $943.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$458.36 / $839.62 / $943.39
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,000.00 / $8,639.91 / $79,506.39
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$820.38 / $1,077.38 / $1,077.38
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 / $1,312.13
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,279.75 / $1,391.03 / $2,642.96
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,060.00 / $3,060.00 / $3,800.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$943.39 / $943.39 / $943.39
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$451.79 / $839.62 / $943.39
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.10 / $1,811.00 / $2,740.60
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,396.46 / $1,396.46 / $1,396.46
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.14 / $517.14 / $1,325.25
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$770.28 / $1,025.47 / $1,025.47
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$770.28 / $1,025.47 / $1,324.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$414.13 / $553.66 / $971.59