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Washington, DC rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,750.50 / $1,750.50 / $2,169.62
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,750.50 / $2,154.19 / $2,169.62
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.90 / $2,153.88 / $6,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,941.88 / $3,728.57 / $5,741.60
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,868.02 / $4,806.03 / $4,806.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.00 / $4,165.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,827.97 / $3,258.31 / $5,818.81