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California rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $5,888 · 10th–90th $2,570$13,8040%5%10%10th90th$5,888Professionalmedian $2,512 · 10th–90th $1,738$7,0790%10%10th90th$2,512$50.0$200.0$1.0K$5.0K$20.0K

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
$1,905.46 / $2,238.72 / $13,182.57
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,238.72 / $7,943.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,630.78 / $6,165.95 / $13,489.63
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $3,548.13 / $6,309.57
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$83.18 / $11,220.18 / $20,892.96
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,388.44 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,818.38 / $5,248.07
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,290.87 / $3,311.31
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $2,290.87 / $4,168.69
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $10,715.19
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15,848.93 / $17,782.79 / $17,782.79
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $1,819.70 / $3,019.95
Optum
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54.95 / $54.95 / $70.79
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,818.38 / $4,365.16
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,884.03 / $5,248.07
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,025.60 / $6,025.60 / $7,413.10
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $11,748.98 / $25,118.86
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,290.87 / $4,570.88