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West Virginia rates for HCPCS V2628

Fabrication and fitting of ocular conformer

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$239.83 / $271.02 / $352.38
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$401.69 / $438.20 / $547.76
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$365.17 / $456.46 / $846.66
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
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.80 / $182.18 / $365.17