go back

Nebraska rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,627.03 / $1,627.03 / $1,977.26
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,627.03 / $1,977.26 / $9,823.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,022.12 / $7,920.73 / $15,321.24
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,713.24 / $2,934.88 / $4,039.92
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,352.73 / $1,352.73 / $1,352.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,396.31 / $4,715.39 / $6,469.75
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,871.08 / $3,262.48 / $7,221.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,789.18 / $4,719.04 / $13,048.80
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,488.00 / $4,412.00 / $5,909.38
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,823.54 / $4,715.39 / $5,681.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,608.58 / $4,270.51 / $5,262.96