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Maine rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.89 / $2,365.32 / $2,846.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,981.01 / $2,302.21 / $3,296.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,167.86 / $3,183.43 / $4,585.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,179.30 / $2,674.87 / $4,740.12
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.89 / $2,368.26 / $2,846.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,128.67 / $3,390.99 / $4,272.42