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Utah rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Professionalmedian $302 · 10th–90th $151–$4170%10%20%10th90th$302$50.0$100.0$200.0$500.0

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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $302.00 / $407.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $354.81 / $446.68
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$269.15 / $346.74 / $426.58
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$416.87 / $489.78 / $489.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$446.68 / $501.19 / $741.31
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $181.97 / $275.42