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South Carolina rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,012.41 / $2,430.39 / $6,632.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.17 / $2,065.08 / $3,304.13
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,577.52 / $10,744.95 / $17,033.70
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,646.24 / $2,098.17 / $3,792.43
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$890.00 / $1,474.50 / $3,013.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,446.12 / $3,139.88 / $4,696.72
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,051.73 / $3,001.85 / $4,587.91
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,383.24 / $1,383.24 / $1,383.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$225.90 / $1,530.31 / $2,850.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $16,223.00 / $23,485.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,848.66 / $2,567.48 / $4,316.17