go back

Minnesota rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,736.70 / $2,139.32 / $2,139.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,736.70 / $2,155.63 / $3,395.04
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,610.82 / $12,653.73 / $23,682.56
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,203.97 / $5,206.13 / $7,445.67
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,206.72 / $7,387.58 / $17,771.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,497.47 / $5,802.62 / $9,098.58
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,733.38 / $6,754.02 / $13,993.56
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,285.69 / $5,225.53 / $8,296.53
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,139.32 / $3,548.32 / $5,866.83
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,541.90 / $4,712.55 / $13,048.80
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,940.00 / $7,872.00 / $11,531.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,472.58 / $4,531.52 / $8,661.76