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Washington rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Facilitymedian $479 · 10th–90th $263–$9770%10%20%10th90th$479Professionalmedian $316 · 10th–90th $151–$4790%10%10th90th$316$50.0$100.0$200.0$500.0$1.0K$2.0K

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 / $316.23 / $398.11
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $549.54
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $177.83 / $177.83
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $467.74 / $1,047.13
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $446.68 / $812.83
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$338.84 / $407.38 / $407.38
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$478.63 / $478.63 / $489.78
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $426.58
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $478.63
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $426.58 / $549.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$501.19 / $501.19 / $501.19
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $181.97 / $346.74
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$302.00 / $426.58 / $426.58