Ocular conformer fabrication and fitting at St Luke's Methodist Hospital

Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.

Model: claude-haiku-5-5
Provider: anthropic
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Max output tokens: 4096
Prompt version (hash): 444523875572
Generated: October 20, 2026

Original text from hospital filings

Fabrication & fitting

Cedar Rapids, IA

See all hospitals reporting HCPCS V2628 →

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Pricing by billing methodology

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How this price compares nationally

St Luke's Methodist Hospital’s median price of $544 is 29% above the median hospital's median price ($421), higher than 83% of the 805 hospitals reporting HCPCS V2628. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.

Payers reporting HCPCS V2628 at St Luke's Methodist Hospital

Negotiated rates from the hospital’s own file: 6 payers, 17 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.

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1	UnitedHealthcare hmo fee schedule · both	$243	$243	—	—	—	$243 – $243
2	UnitedHealthcare ppo fee schedule · both	$243	$243	—	—	—	$243 – $243
3	Aetna medicare advantage case rate · outpatient	$497	$497	—	—	—	$497 – $497
4	Molina medicare advantage case rate · outpatient	$497	$497	—	—	—	$497 – $497
5	Wellmark medicare advantage case rate · outpatient	$497	$497	—	—	—	$497 – $497
6	Humana medicare advantage case rate · outpatient	$511	$511	—	—	—	$511 – $511
7	UnitedHealthcare medicare advantage case rate · outpatient	$511	$511	—	—	—	$511 – $511
8	Aetna hmo fee schedule · both	$544	$544	—	—	—	$544 – $544
9	Aetna ppo fee schedule · both	$544	$544	—	—	—	$544 – $544
10	Wellmark commercial fee schedule · both	$552	$552	—	—	—	$552 – $552
11	Wellmark hmo fee schedule · both	$552	$552	—	—	—	$552 – $552
12	Wellmark ppo fee schedule · both	$552	$552	—	—	—	$552 – $552
13	UnitedHealthcare hmo fee schedule · outpatient	$584	$584	—	—	—	$584 – $584
14	UnitedHealthcare ppo fee schedule · outpatient	$584	$584	—	—	—	$584 – $584
15	Aetna hmo fee schedule · outpatient	$901	$901	—	—	—	$901 – $901
16	Aetna ppo fee schedule · outpatient	$901	$901	—	—	—	$901 – $901
17	Cigna commercial fee schedule · both	$927	$927	—	—	—	$927 – $927

Last updated: Jan 28, 2026

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