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Utah rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $3,388 · 10th–90th $2,951–$14,1250%20%10th90th$3,388Professionalmedian $2,951 · 10th–90th $1,738–$10,2330%10%10th90th$2,951$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
$2,951.21 / $2,951.21 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,951.21 / $10,232.93
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $2,818.38 / $3,890.45
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $3,801.89
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$8,511.38 / $11,481.54 / $17,782.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $3,235.94 / $5,623.41
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,995.26 / $3,548.13 / $4,570.88
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $2,951.21 / $4,265.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,290.87 / $3,715.35