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Louisiana rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,286.79 / $2,713.87 / $4,063.60
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,804.49 / $2,713.87 / $3,614.11
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,783.10 / $8,674.20 / $11,969.08
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,214.09 / $2,714.75 / $3,952.01
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $1,507.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,892.65 / $2,818.66 / $4,004.08
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,141.00 / $4,717.00 / $11,696.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,881.30 / $2,642.95 / $4,306.47