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Hawaii rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.76 / $319.76 / $413.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $405.36
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.00 / $916.23 / $916.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$515.91 / $515.91 / $515.91
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.63 / $219.10 / $459.62
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.02 / $322.68 / $350.75