go back

Arizona rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,597.99 / $1,992.10 / $9,823.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.60 / $1,651.20 / $2,700.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,031.29 / $2,554.79 / $2,906.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,796.35 / $2,568.89 / $4,367.95
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.56 / $2,643.54 / $6,506.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,048.96 / $2,721.23 / $15,904.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,637.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,896.59 / $2,314.59 / $4,237.54