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Idaho rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.79 / $397.54 / $426.34
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
$276.52 / $401.69 / $486.90
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$372.60 / $462.56 / $486.90
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.89 / $754.70 / $949.46
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.83 / $340.83 / $511.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.44 / $174.58 / $182.18