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Wyoming rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,745.56 / $2,155.63 / $2,727.08
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,006.39 / $5,006.39 / $5,006.39
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,310.00 / $4,053.00 / $6,131.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,846.51 / $3,702.73 / $5,910.30
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,188.00 / $5,188.00 / $18,767.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,800.98 / $4,459.88 / $7,953.38