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Minnesota rates for HCPCS V2628

Fabrication And Fitting Of Ocular Conformer

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.87 / $305.87 / $305.87
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.23 / $305.87 / $413.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$342.97 / $342.97 / $342.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.25 / $500.00 / $500.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$833.41 / $1,042.81 / $1,311.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$427.61 / $465.71 / $537.69
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$833.41 / $1,032.48 / $2,166.13
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$423.38 / $423.38 / $423.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.39 / $361.19 / $397.92
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.45 / $151.82 / $346.06
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.45 / $151.82 / $366.69