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Arizona rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,187.76 / $6,025.60
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,348.96 / $1,995.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $2,754.23 / $5,128.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,570.40 / $4,365.16
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,691.53 / $7,079.46
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,041.74 / $3,090.30 / $15,848.93
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $6,025.60 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,290.87 / $3,801.89