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Montana rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $3,548 · 10th–90th $2,951–$4,1690%20%10th90th$3,548Professionalmedian $3,020 · 10th–90th $1,738–$5,3700%10%10th90th$3,020$100.0$200.0$500.0$1.0K$2.0K$5.0K$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
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,754.23 / $5,888.44
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $2,754.23 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,818.38 / $3,548.13
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,951.21 / $3,630.78 / $4,168.69
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $3,630.78 / $4,168.69
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,090.30 / $4,466.84
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $2,951.21 / $4,265.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,467.37 / $4,570.88