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Nebraska rates for HCPCS V2624

Polishing/resurfacing of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$59.12 / $59.12 / $59.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$59.12 / $61.20 / $80.36
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.79 / $71.34 / $71.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $84.75 / $105.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.64 / $88.68 / $132.75
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$27.82 / $36.46 / $57.19
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$71.00 / $80.38 / $142.49
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.75 / $72.78 / $165.58
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$26.43 / $36.46 / $43.84