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Massachusetts rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.79 / $232.08 / $323.33
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$315.97 / $356.61 / $534.91
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.49 / $247.85 / $2,219.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,200.00 / $3,200.00 / $3,200.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $194.01
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.77 / $297.77 / $297.77
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.66 / $182.18 / $2,424.76
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.63 / $182.18 / $356.61