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Illinois rates for HCPCS V2624

Polishing/resurfacing of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.95 / $55.64 / $69.55
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.04 / $109.61 / $109.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $35.07 / $85.60
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$57.54 / $79.18 / $124.56
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$29.19 / $102.30 / $1,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.54 / $36.46 / $52.29