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Wisconsin rates for HCPCS V2627

Scleral cover shell

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,445.44 / $1,445.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,380.38 / $1,621.81
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $1,737.80 / $2,089.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $5,370.32 / $7,413.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $2,511.89 / $3,311.31
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,445.44 / $1,698.24
DeanCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,089.30 / $3,981.07
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,621.81 / $2,691.53
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $1,584.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $58.88 / $1,412.54
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,630.27 / $4,677.35
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $3,467.37 / $8,128.31
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $2,630.27 / $10,232.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $794.33 / $1,288.25