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Missouri rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.76 / $352.38 / $413.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.16 / $301.58 / $426.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$171.17 / $175.28 / $175.28
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.57 / $463.43 / $823.30
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.82 / $240.74 / $742.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.63 / $235.33 / $499.93