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Virginia rates for HCPCS V2624

Polishing/resurfacing of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.95 / $60.22 / $79.55
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.36 / $92.73 / $92.73
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$64.81 / $64.81 / $64.81
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$93.09 / $93.09 / $93.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $35.07 / $35.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$82.82 / $92.56 / $115.94
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46.88 / $64.23 / $108.84
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$53.38 / $132.00 / $228.34
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$61.84 / $78.65 / $121.76
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.84 / $78.65 / $121.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.46 / $48.61 / $58.46