go back

New Hampshire rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$145.30 / $166.52 / $344.16
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$274.16 / $301.58 / $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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.66 / $182.18 / $242.90
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$242.90 / $267.19 / $340.06