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Idaho rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,130.52 / $2,961.88 / $4,392.57
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,082.63 / $1,082.63 / $1,085.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,408.83 / $3,013.95 / $4,037.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,780.50 / $3,650.09 / $5,132.77
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,821.76 / $3,457.95 / $4,288.28
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $3,033.04 / $3,815.76
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,660.78 / $14,097.25 / $17,807.80
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,936.87 / $3,595.74 / $4,339.71
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,433.13 / $3,457.63 / $4,971.59