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New Jersey rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $5,623 · 10th–90th $2,138–$16,5960%10%10th90th$5,623Professionalmedian $2,188 · 10th–90th $1,622–$5,3700%10%10th90th$2,188$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
$1,905.46 / $2,818.38 / $3,630.78
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,187.76 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $3,090.30 / $6,456.54
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,691.53 / $3,715.35
Horizon BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12,022.64 / $19,054.61 / $30,199.52
Horizon BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $2,041.74 / $6,760.83
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,890.45 / $8,709.64 / $15,488.17
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,513.56 / $2,290.87 / $5,495.41