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Maine rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.23 / $209.50 / $317.99
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$858.88 / $858.88 / $858.88
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.16 / $274.16 / $301.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $175.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$297.77 / $297.77 / $297.77
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.23 / $209.50 / $317.99
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.63 / $182.18 / $418.96