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Fabrication and Fitting of Ocular Conformer

Montana rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Rates data updated July 2026.

Facilitymedian $479 · 10th–90th $316$5890%20%40%10th90th$479Professionalmedian $398 · 10th–90th $182$4790%50%10th90th$398$100.0$200.0$500.0$1.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$398.11
Typical High
$398.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$177.83
Typical High
$177.83
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$371.54
Median
$478.63
Typical High
$588.84
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$478.63
Typical High
$588.84
Providence
Setting
Facility
Modifier
Global
Typical Low
$234.42
Median
$371.54
Typical High
$501.19
Providence
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$177.83
United
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$181.97
Typical High
$275.42