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Georgia rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.76 / $316.61 / $352.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.04 / $393.04 / $393.04
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$256.33 / $361.37 / $652.51
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.04 / $569.91 / $628.86
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
$314.43 / $393.04 / $683.18
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.72 / $182.18 / $265.83