go back

Maryland rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,686.81 / $2,066.26 / $2,597.71
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,902.90 / $1,976.04 / $2,347.65
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $641.21 / $851.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,743.60 / $2,842.85 / $5,112.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,219.96 / $2,863.75 / $3,869.67
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,827.97 / $2,487.23 / $4,179.07
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,804.31 / $2,552.94 / $3,180.66