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South Dakota rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $2,455 · 10th–90th $1,738–$4,7860%10%20%10th90th$2,455Professionalmedian $2,754 · 10th–90th $1,738–$5,1290%10%10th90th$2,754$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
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,862.09 / $2,137.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,137.96 / $4,168.69
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,548.13 / $5,011.87 / $6,309.57
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,388.44 / $5,623.41
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $5,370.32 / $15,848.93
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,570.88 / $5,495.41
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $4,570.88 / $5,623.41
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,548.13 / $4,365.16
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,630.78 / $6,025.60
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,388.44 / $4,168.69 / $5,128.61