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Pennsylvania rates for HCPCS V2627

Scleral cover shell

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.24 / $1,192.82 / $1,505.27
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,546.55 / $1,546.55 / $1,546.55
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,014.52 / $2,014.52 / $2,014.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.34 / $742.34 / $742.34
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,087.28 / $2,569.26 / $4,117.64
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,044.31 / $1,044.31 / $1,159.91
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$625.24 / $1,205.26 / $1,505.27
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,014.52 / $2,014.52 / $2,014.52
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.34 / $742.34 / $742.34
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,105.72 / $1,105.72 / $1,472.03
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.72 / $1,472.03 / $1,806.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$697.34 / $771.56 / $1,285.93