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New York rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $316.23 / $398.11
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $758.58 / $758.58
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $691.83
CDPHP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $309.03 / $309.03
CDPHP
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $309.03 / $309.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $676.08 / $676.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $173.78 / $446.68
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $489.78 / $812.83
Excellus BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Excellus BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $234.42 / $316.23
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $363.08 / $489.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $186.21 / $302.00
Univera
Facility/Professional
Facility
Modifier
Low / Median / High Price
$213.80 / $213.80 / $213.80
Univera
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $234.42 / $380.19