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Alaska rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,283.27 / $5,283.27 / $6,241.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,620.34 / $8,960.59 / $10,585.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,574.82 / $6,433.26 / $9,073.99
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,956.95 / $8,960.59 / $14,819.21
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,275.39 / $6,287.19 / $12,634.05
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,608.75 / $9,394.54 / $13,870.35
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,956.95 / $8,997.37 / $14,819.21
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,059.30 / $9,604.50 / $14,606.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,001.18 / $10,502.07 / $13,202.60