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Minnesota rates for HCPCS V2624

Polishing/Resurfacing Of Ocular Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.20 / $61.20 / $61.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.32 / $61.20 / $78.98
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$69.66 / $69.66 / $69.66
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$52.00 / $85.00 / $85.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.84 / $208.75 / $262.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.60 / $93.23 / $107.63
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$166.84 / $206.69 / $433.62
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.75 / $84.75 / $84.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$49.92 / $72.86 / $79.70
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.30 / $30.38 / $69.23
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$24.30 / $30.38 / $68.11