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West Virginia 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
$943.39 / $943.39 / $943.39
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$517.75 / $764.15 / $943.39
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$700.30 / $1,454.46 / $1,885.42
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$754.17 / $969.64 / $1,292.85
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 / $5,852.97
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$450.50 / $596.72 / $899.85