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Virginia rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$150.79 / $239.83 / $384.05
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$301.58 / $463.43 / $463.43
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$224.59 / $224.59 / $224.59
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$481.11 / $481.11 / $481.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$175.28 / $175.28 / $175.28
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$310.39 / $346.91 / $434.55
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$224.59 / $261.87 / $408.02
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.07 / $493.00 / $855.86
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.80 / $300.92 / $456.36
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.80 / $300.92 / $456.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.42 / $182.18 / $219.60