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South Carolina rates for HCPCS V2623

Prosthetic eye, plastic, custom

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $870.96 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $870.96 / $1,122.02
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,513.56 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $1,949.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $512.86 / $1,479.11
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$645.65 / $724.44 / $724.44
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,000.00 / $1,905.46
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $371.54 / $371.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$426.58 / $812.83 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $537.03 / $676.08