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Washington rates for HCPCS V2627

Scleral cover shell

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$638.59 / $1,437.92 / $1,700.82
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,805.62 / $2,381.33 / $7,992.50
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.68 / $2,060.85 / $13,897.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$742.34 / $742.34 / $742.34
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,084.69 / $1,906.95 / $5,002.58
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,094.83 / $1,903.68 / $3,446.29
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,748.93 / $2,137.58 / $2,188.89
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,962.50 / $2,013.74 / $2,062.07
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,805.62 / $1,805.62 / $1,805.62
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.68 / $1,953.33 / $2,315.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,647.59 / $1,752.76 / $2,268.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.37 / $771.56 / $1,472.03