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Orbital Prosthesis, Provided by a Nonphysician

Pennsylvania rates for HCPCS L8042

Orbital prosthesis, provided by a nonphysician

Rates data updated July 2026.

How much does Orbital Prosthesis, Provided by a Nonphysician cost?

$1,995

Typical negotiated rate. In Pennsylvania, July 2026.

Insurers have agreed to pay about $1,995 for this service. The price depends on where it is billed: about $1,995 from a physician practice, and about $4,898 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 8 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$1,995$1,820 to $2,692
FacilityA hospital or hospital-owned outpatient department$4,898$1,820 to $7,079

How much rates vary

Facilitymedian $4,898 · 10th to 90th $1,820 to $17,783Professionalmedian $1,995 · 10th to 90th $1,698 to $3,388
$1.0$10.0$100.0$1.0K$10.0Kfacility $4,898professional $1,995

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$7,079.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$1,995.26
Typical High
$2,884.03
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$8,511.38
Typical High
$77,624.71
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$2,290.87
Median
$3,311.31
Typical High
$4,168.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,235.94
Median
$3,235.94
Typical High
$5,623.41
Cigna
Setting
Professional
Modifier
Global
Typical Low
$2,754.23
Median
$2,754.23
Typical High
$3,235.94
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$4,168.69
Median
$5,888.44
Typical High
$8,511.38
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$4,168.69
Median
$4,168.69
Typical High
$4,168.69
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$2,511.89
Median
$2,884.03
Typical High
$4,168.69
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,819.70
Typical High
$7,079.46
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,995.26
Typical High
$2,884.03
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$3,890.45
Median
$14,454.40
Typical High
$23,442.29
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$2,884.03
Median
$3,890.45
Typical High
$3,981.07
United
Setting
Facility
Modifier
Global
Typical Low
$645.65
Median
$2,630.27
Typical High
$4,897.79
United
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$2,290.87
Typical High
$4,570.88

Where Pennsylvania sits

The same service costs 5.8 times more in Hawaii than in Nebraska. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Pennsylvania $1,995 · 46th of 51
HI $10,000NE $1,738

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.