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Tennessee rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,605.40 / $3,491.99 / $4,785.93
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,605.40 / $2,146.16 / $3,366.89
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,835.00 / $5,486.00 / $9,419.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,027.87 / $2,880.06 / $4,421.50
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,021.78 / $2,950.14 / $4,677.20
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $8,663.57 / $8,663.57
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,931.36 / $15,775.28 / $17,883.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,905.00 / $6,073.00 / $10,287.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,964.20 / $2,749.23 / $4,789.52