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Connecticut rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,165.98 / $3,316.55 / $4,057.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,760.37 / $2,365.32 / $5,298.73
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,920.00 / $11,936.00 / $15,915.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,788.17 / $3,455.74 / $5,044.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$843.00 / $2,470.92 / $2,470.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,600.46 / $3,979.82 / $5,531.08
ConnectiCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,330.14 / $4,873.00 / $4,974.00
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,832.54 / $3,481.77 / $4,223.85
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,644.00 / $8,468.00 / $13,943.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,974.24 / $3,701.70 / $6,255.75