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Minnesota rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,737.80 / $2,137.96 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,137.96 / $3,388.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $14,791.08 / $42,657.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,019.95 / $4,570.88 / $7,413.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $7,762.47 / $18,620.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,467.37 / $5,888.44 / $9,120.11
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,025.60 / $7,413.10 / $14,791.08
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,548.13 / $5,370.32 / $8,511.38
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $3,548.13 / $6,165.95
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,238.72 / $4,570.88 / $13,182.57
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,168.69 / $7,943.28 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,890.45 / $7,079.46