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Florida rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,778.28 / $2,041.74 / $2,570.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,187.76 / $3,388.44
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$34.67 / $891.25 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,691.53 / $4,466.84
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $12,022.64 / $22,908.68
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,737.80 / $2,818.38
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $1,348.96 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $10,232.93 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,238.72 / $3,890.45
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $1,659.59 / $2,238.72