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Illinois rates for HCPCS V2628

Fabrication And Fitting Of Ocular Conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.52 / $295.44 / $393.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$534.91 / $547.76 / $547.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $427.61
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$287.57 / $395.77 / $630.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.57 / $511.24 / $1,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.63 / $182.18 / $322.58