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California rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,924.20 / $2,251.52 / $13,557.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,721.08 / $2,152.73 / $9,823.40
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,393.42 / $5,977.00 / $13,012.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,282.00 / $3,137.02 / $5,999.47
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.80 / $100.00 / $16,022.33
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,860.46 / $2,657.80 / $5,717.61
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,771.04 / $1,774.17 / $3,172.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,108.32 / $2,794.97 / $5,241.17
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,964.77 / $2,511.89 / $3,139.86
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,741.61 / $2,455.96 / $4,190.88
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $8,003.55 / $8,663.57
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,931.36 / $15,775.28 / $17,883.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,073.30 / $2,741.14 / $3,825.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,133.17 / $2,954.29 / $5,322.22
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,095.24 / $6,095.24 / $7,368.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,799.00 / $12,341.00 / $26,451.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,792.85 / $2,433.13 / $5,275.75