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North Carolina rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,711.17 / $2,065.08 / $3,942.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,711.17 / $2,065.08 / $3,942.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,590.24 / $1,590.24 / $1,613.44
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,242.92 / $3,709.34 / $5,605.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $1,547.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,242.55 / $3,213.51 / $5,488.29
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.39 / $2,832.00 / $4,394.97
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,778.00 / $3,143.00 / $3,143.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $2,788.80 / $6,509.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,183.00 / $12,216.00 / $19,066.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,964.20 / $2,977.98 / $5,536.90
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $8,663.57 / $8,663.57
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$12,931.36 / $15,775.28 / $17,883.00