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Arizona rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.79 / $253.73 / $393.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.87 / $95.87 / $105.46
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$267.64 / $267.64 / $319.57
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $175.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$177.23 / $326.95 / $407.82
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.44 / $182.18 / $2,424.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.44 / $182.18 / $261.36