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Michigan 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 / $344.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.17 / $365.17 / $365.17
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.91 / $383.43 / $492.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $529.22
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.21 / $295.44 / $361.48
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$270.23 / $310.76 / $486.41
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.63 / $171.49 / $242.90