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Fabrication and Fitting of Ocular Conformer

Wisconsin rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Rates data updated July 2026.

Facilitymedian $363 · 10th–90th $302$1,2020%20%10th90th$363Professionalmedian $316 · 10th–90th $151$5250%10%20%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
Setting
Facility
Modifier
Global
Typical Low
$309.03
Median
$309.03
Typical High
$309.03
Aetna
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$309.03
Typical High
$380.19
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$346.74
Typical High
$426.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,202.26
Typical High
$1,737.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$524.81
Typical High
$707.95
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$323.59
Typical High
$398.11
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$331.13
Median
$446.68
Typical High
$741.31
Medica
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$363.08
Typical High
$562.34
Medica
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$181.97
Typical High
$338.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$58.88
Typical High
$363.08
Network Health
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$363.08
Typical High
$562.34
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$323.59
Typical High
$398.11
Quartz
Setting
Professional
Modifier
Global
Typical Low
$371.54
Median
$575.44
Typical High
$1,096.48
Quartz
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$1,995.26
Quartz
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$549.54
Typical High
$2,454.71
United
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$181.97
Typical High
$275.42