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Washington rates for HCPCS V2624

Polishing/resurfacing of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.17 / $61.20 / $80.36
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.31 / $131.33 / $378.85
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.54 / $97.37 / $535.20
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$35.07 / $35.07 / $35.07
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$51.46 / $90.47 / $236.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$51.94 / $90.24 / $162.91
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.22 / $82.15 / $82.15
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.34 / $92.92 / $97.43
Pacific Source
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.69 / $97.43 / $97.43
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$85.31 / $85.31 / $85.31
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.87 / $95.14 / $140.02
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$77.84 / $82.82 / $107.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$33.70 / $36.46 / $69.55