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Alabama rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,808.12 / $2,808.12 / $3,366.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,690.09 / $2,187.15 / $3,366.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$404.28 / $489.41 / $658.42
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,735.94 / $2,615.80 / $3,048.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,767.89 / $2,659.23 / $7,297.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,485.00 / $4,121.00 / $7,227.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,617.57 / $2,241.50 / $3,841.61