go back

New Mexico rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,785.26 / $1,785.26 / $2,167.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,785.26 / $2,167.67 / $4,467.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,034.08 / $3,077.05 / $4,112.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $363.02 / $3,025.16
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,932.60 / $2,759.56 / $3,599.08
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,250.57 / $3,282.19 / $4,594.18
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,463.30 / $3,364.87 / $4,506.10