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Kentucky rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$261.87 / $261.87 / $261.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.79 / $278.06 / $374.10
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.95 / $274.16 / $463.43
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$393.04 / $530.60 / $687.82
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$419.95 / $511.24 / $821.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$481.11 / $481.11 / $481.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $462.57
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$250.49 / $250.49 / $250.49
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.45 / $182.18 / $251.07