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Texas rates for HCPCS V2624

Polishing/resurfacing of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$37.58 / $68.55 / $83.94
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$78.41 / $78.41 / $78.41
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.00 / $80.00 / $80.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $35.07 / $35.07
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$142.25 / $148.33 / $378.85
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$482.28 / $482.28 / $548.03
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.65 / $74.70 / $95.86
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.69 / $92.56 / $92.56
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$57.65 / $75.68 / $95.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $35.07 / $72.51
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.38 / $44.94 / $52.29
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.36 / $95.86 / $129.41