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Alaska rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $3,890 · 10th–90th $1,862–$11,7490%5%10th90th$3,890Professionalmedian $2,884 · 10th–90th $1,862–$8,5110%10%10th90th$2,884$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $5,495.41 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,454.71 / $5,888.44
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $3,630.78 / $7,585.78
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $3,890.45 / $10,471.29
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,801.89 / $6,165.95 / $10,964.78
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,918.31 / $8,511.38 / $12,589.25
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $3,801.89 / $10,471.29
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$60.26 / $3,235.94 / $6,456.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,754.40 / $5,754.40 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $8,912.51 / $12,589.25