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Washington rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $3,890 · 10th–90th $2,138–$6,4570%10%20%10th90th$3,890Professionalmedian $2,884 · 10th–90th $1,778–$5,1290%10%20%10th90th$2,884$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
$2,754.23 / $3,981.07 / $6,025.60
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,454.71 / $4,786.30
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $15,488.17 / $31,622.78
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,454.71 / $3,715.35 / $5,370.32
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $758.58 / $2,137.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,467.37 / $5,888.44
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $3,388.44 / $5,623.41
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,949.84 / $3,388.44 / $5,248.07
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,258.93
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $4,265.80 / $4,897.79
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,818.38 / $2,884.03
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,467.37 / $5,248.07
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,715.19 / $16,218.10 / $31,622.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,715.35 / $5,370.32
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $17,378.01 / $33,884.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $3,235.94 / $5,370.32
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,454.71 / $3,162.28