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Wisconsin rates for HCPCS 21077

Impression and custom preparation; orbital prosthesis

Facilitymedian $9,772 · 10th–90th $2,951$16,9820%5%10%10th90th$9,772Professionalmedian $2,754 · 10th–90th $1,698$8,5110%10%10th90th$2,754$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
$1,698.24 / $3,630.78 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,089.30 / $4,677.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $10,964.78 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $3,548.13 / $9,332.54
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,623.41 / $6,456.54 / $10,471.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,248.07 / $10,000.00
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,818.38 / $4,897.79
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,235.94 / $4,466.84 / $6,760.83
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $3,630.78 / $13,182.57
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $4,897.79 / $15,848.93
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $2,754.23
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,168.69 / $9,332.54 / $15,848.93
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,691.53 / $5,888.44 / $8,317.64
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $4,897.79 / $7,585.78
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $4,570.88 / $10,715.19
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,162.28 / $10,964.78 / $15,848.93
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5,754.40 / $5,754.40 / $6,918.31
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$7,585.78 / $11,220.18 / $13,489.63
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$7,585.78 / $12,022.64 / $15,848.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,089.30 / $3,388.44 / $8,511.38