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Alaska rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$328.00 / $397.54 / $413.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $175.28
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$259.01 / $328.00 / $397.54
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$327.38 / $344.61 / $462.56
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.39 / $336.53 / $404.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$316.61 / $328.00 / $397.54
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $247.95 / $403.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.70 / $182.18 / $881.27