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Wisconsin rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Facilitymedian $363 · 10th–90th $302$1,2880%20%10th90th$363Professionalmedian $324 · 10th–90th $151$5250%10%10th90th$324$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
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $302.00 / $302.00
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$151.36 / $302.00 / $398.11
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $426.58
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,148.15 / $1,584.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $524.81 / $707.95
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$269.15 / $323.59 / $398.11
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$331.13 / $446.68 / $741.31
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$302.00 / $363.08 / $562.34
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $181.97 / $338.84
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $58.88 / $363.08
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $363.08 / $562.34
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$371.54 / $562.34 / $1,096.48
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$741.31 / $741.31 / $1,949.84
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $1,659.59 / $2,398.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $181.97 / $275.42