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South Carolina 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
$871.65 / $871.65 / $871.65
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$861.72 / $871.65 / $968.97
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,149.21 / $1,149.21 / $1,149.21
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,077.38 / $1,600.00 / $2,017.17
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
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$525.58 / $912.75 / $1,692.03
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.00 / $755.87 / $755.87
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$728.02 / $728.02 / $3,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$361.91 / $513.53 / $662.61