go back

Massachusetts rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,958.00 / $1,958.00 / $2,365.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,750.50 / $2,365.32 / $3,780.86
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,591.00 / $5,097.00 / $10,667.33
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,858.81 / $3,875.62 / $15,775.28
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,025.49 / $2,602.75 / $4,646.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,190.71 / $3,550.60 / $6,116.65
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $2,747.62 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,464.92 / $2,985.85 / $4,062.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,219.69 / $4,590.99 / $6,183.35
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,063.00 / $12,850.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,675.09 / $4,677.74 / $15,775.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $5,097.00 / $10,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,544.91 / $3,569.24 / $8,639.39