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Minnesota rates for HCPCS V2627

Scleral Cover Shell (Special Coverage Instructions Apply. See Cim: 65-3)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,437.92 / $1,437.92 / $1,437.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$775.13 / $1,388.90 / $1,708.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,612.37 / $1,612.37 / $1,612.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,430.62 / $2,880.00 / $2,880.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,918.34 / $4,902.81 / $6,164.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,010.03 / $2,189.14 / $2,527.46
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,918.34 / $4,854.27 / $10,184.19
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,990.13 / $1,990.13 / $1,990.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,056.88 / $1,505.27 / $1,802.56
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.37 / $683.92 / $1,465.63
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.37 / $683.92 / $1,567.59