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Hawaii rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $2,884 · 10th–90th $2,884–$2,8840%50%100%$2,884Professionalmedian $2,291 · 10th–90th $1,738–$3,7150%10%20%10th90th$2,291$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,187.76 / $3,801.89
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,754.23 / $3,311.31
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $3,090.30 / $3,388.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,511.89 / $2,951.21
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $2,884.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,630.27 / $2,951.21
University Health Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$363.08 / $2,137.96 / $2,884.03