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New Jersey rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,154.19 / $2,422.00 / $3,169.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,721.08 / $2,154.19 / $3,351.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,878.85 / $3,199.33 / $6,653.67
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,496.34 / $3,305.85 / $4,086.64
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,606.42 / $14,382.16 / $31,187.56
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,485.26 / $2,252.85 / $5,096.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,682.00 / $9,969.00 / $19,696.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,677.76 / $2,625.23 / $6,060.44