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Utah rates for HCPCS V2624

Polishing/resurfacing of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$23.53 / $38.72 / $80.36
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $35.07 / $35.07
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $75.59 / $91.57
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.68 / $65.04 / $68.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.54 / $36.46 / $54.91