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Ohio rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.23 / $271.02 / $395.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$182.95 / $237.83 / $473.99
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$365.17 / $474.72 / $547.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$401.69 / $474.72 / $876.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $175.28
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $175.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.01 / $265.52 / $320.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.45 / $177.05 / $223.64