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Pennsylvania rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $2,138 · 10th–90th $1,778$15,4880%20%10th90th$2,138Professionalmedian $2,138 · 10th–90th $1,698$3,7150%20%10th90th$2,138$10.0$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
$1,778.28 / $1,778.28 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,137.96 / $3,388.44
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,238.72 / $4,466.84
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,630.27 / $4,265.80
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,548.13 / $4,466.84
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,884.03 / $5,011.87
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $2,137.96
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,041.74 / $2,818.38
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,890.45 / $5,370.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $1,698.24 / $3,235.94
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $1,698.24 / $2,089.30
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,754.40 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,398.83 / $3,981.07