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Arkansas rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,523.41 / $2,968.59 / $3,505.08
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,708.85 / $2,523.41 / $3,350.88
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,430.62 / $5,430.62 / $6,516.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,873.74 / $2,479.94 / $3,012.83
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,337.37 / $4,337.37 / $4,337.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,361.67 / $3,392.81 / $4,174.63
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,565.00 / $2,667.00 / $6,957.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,079.73 / $3,075.96 / $4,248.53