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Colorado rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.56 / $1,745.56 / $2,155.63
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,690.09 / $2,155.63 / $2,715.51
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,946.00 / $9,472.00 / $17,487.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,957.95 / $2,450.77 / $3,891.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,291.69 / $1,291.69 / $4,068.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,159.39 / $2,912.75 / $4,415.24
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,901.11 / $2,865.66 / $3,734.99
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,134.28 / $2,799.81 / $4,055.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,251.00 / $11,924.00 / $19,712.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,433.13 / $3,350.69 / $4,972.00