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Indiana rates for HCPCS V2628

Fabrication And Fitting Of Ocular Conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$253.73 / $280.58 / $376.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$241.26 / $301.58 / $406.28
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.17 / $474.72 / $511.24
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.17 / $401.69 / $456.46
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $398.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.45 / $173.36 / $233.27