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South Carolina rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $2,454.71 / $6,606.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,187.76 / $4,168.69
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $9,772.37 / $17,378.01
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,187.76 / $3,890.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $891.25 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,090.30 / $4,677.35
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,365.16 / $4,365.16 / $4,897.79
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $2,951.21 / $4,897.79
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $33.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $17,378.01 / $26,302.68
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,290.87 / $3,890.45