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Missouri rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,466.18 / $1,780.50 / $2,209.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,590.13 / $1,935.46 / $3,341.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,057.38 / $2,521.30 / $4,018.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,983.56 / $2,863.75 / $4,535.58
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,684.76 / $2,851.15 / $5,504.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,310.82 / $3,488.79 / $15,904.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,156.00 / $4,000.00 / $10,781.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,833.46 / $2,690.98 / $4,283.82