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Washington, DC rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.13 / $239.83 / $413.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.59 / $224.59 / $224.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $175.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.17 / $365.17 / $365.17
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.80 / $219.10 / $319.97