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Kentucky rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,471.19 / $1,801.39 / $2,694.05
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,648.23 / $1,956.95 / $2,694.05
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,212.00 / $9,015.00 / $11,253.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,731.71 / $2,083.86 / $2,965.60
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,292.67 / $2,292.67 / $2,451.89
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,931.32 / $2,737.83 / $4,445.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,404.38 / $3,013.24 / $3,013.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,994.78 / $2,927.97 / $4,558.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,568.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.00 / $4,539.00 / $10,113.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,161.58 / $3,077.99 / $4,498.14