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Utah 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
$347.00 / $347.00 / $347.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$347.00 / $861.56 / $4,144.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,003.00 / $2,003.00 / $2,003.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.14 / $517.14 / $1,640.16
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.97 / $832.21 / $1,081.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$998.20 / $1,113.25 / $1,113.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.92 / $797.98 / $1,196.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$412.96 / $537.49 / $895.82