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Illinois rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $4,467 · 10th–90th $1,698–$10,2330%10%20%10th90th$4,467Professionalmedian $2,344 · 10th–90th $1,698–$4,5710%20%10th90th$2,344$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
$1,698.24 / $3,890.45 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,238.72 / $4,365.16
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $9,120.11 / $37,153.52
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,818.38 / $4,570.88
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $3,388.44 / $10,000.00
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $2,238.72 / $2,884.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $2,398.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $5,370.32 / $12,302.69
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,630.27 / $4,265.80