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Texas rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $2,630 · 10th–90th $1,096$6,6070%5%10th90th$2,630Professionalmedian $2,239 · 10th–90th $1,698$3,8020%10%10th90th$2,239$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
$1,584.89 / $1,819.70 / $2,691.53
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,238.72 / $3,388.44
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$977.24 / $1,584.89 / $4,265.80
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $2,041.74 / $3,311.31
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$79.43 / $1,513.56 / $1,548.82
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,019.95 / $3,019.95
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,818.38 / $4,677.35
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $10,715.19
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$15,848.93 / $17,782.79 / $17,782.79
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,818.38 / $4,677.35
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,570.40 / $4,073.80
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,479.11
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,019.95 / $3,019.95 / $3,019.95
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,818.38 / $4,677.35
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,818.38 / $4,466.84
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,238.72 / $6,165.95 / $11,481.54
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,290.87 / $3,548.13
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,187.76 / $2,238.72