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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
$1,690.09 / $1,870.38 / $2,219.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,690.09 / $2,063.08 / $2,784.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $898.90 / $1,070.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,614.67 / $2,651.83 / $4,437.29
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,979.00 / $12,804.00 / $23,031.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,039.99 / $2,090.11 / $2,681.92
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.68 / $1,545.42 / $2,704.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,581.00 / $10,309.00 / $15,888.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,646.39 / $2,391.15 / $4,201.62
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,349.90 / $1,654.25 / $1,654.25