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Mississippi rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,603.62 / $1,915.09 / $4,106.58
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,603.62 / $2,251.52 / $4,106.58
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,287.85 / $1,287.85 / $1,287.85
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,723.00 / $4,723.00 / $4,723.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$833.37 / $932.95 / $6,486.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,095.77 / $3,465.11 / $4,725.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$985.00 / $3,572.00 / $9,515.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,906.54 / $2,568.71 / $5,576.47