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Oklahoma rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.44 / $1,852.44 / $2,222.02
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,765.89 / $1,852.44 / $2,222.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,453.83 / $1,453.83 / $1,453.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,895.99 / $2,759.27 / $3,967.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,852.44 / $2,834.32 / $7,276.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,964.20 / $2,719.97 / $15,904.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,910.00 / $9,232.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,835.84 / $2,338.00 / $3,280.61