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Nebraska rates for HCPCS V2625

Enlargement of ocular prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$479.20 / $479.20 / $479.20
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$314.45 / $479.20 / $563.77
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.50 / $578.41 / $578.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.23 / $670.88 / $838.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$440.63 / $594.92 / $1,076.03
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.00 / $295.50 / $463.59
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.00 / $651.54 / $1,155.00
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$499.31 / $533.62 / $1,342.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$197.00 / $280.73 / $295.50