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Tennessee rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.76 / $317.99 / $361.48
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.77 / $432.34 / $432.34
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $175.28
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$619.47 / $741.30 / $1,957.92
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,424.76 / $2,424.76 / $2,781.83
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$121.45 / $177.05 / $210.10