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North Dakota rates for HCPCS 21077

Impression & Preparation Orbital Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,875.10 / $1,875.10 / $2,257.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,736.70 / $2,069.44 / $2,257.29
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,945.93 / $4,484.01 / $5,494.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,573.44 / $4,391.39 / $5,735.04
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,875.10 / $2,970.68 / $3,837.39
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,352.78 / $4,517.42 / $13,048.80
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,352.78 / $4,266.46 / $5,880.38