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Illinois rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Facilitymedian $1,549 · 10th–90th $692–$3,1620%10%10th90th$1,549Professionalmedian $1,072 · 10th–90th $692–$2,6920%10%10th90th$1,072$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
$691.83 / $1,548.82 / $1,819.70
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $912.01 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $2,691.53 / $29,512.09
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,187.76 / $2,630.27 / $3,162.28
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $758.58
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$776.25 / $1,148.15 / $1,862.09
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $1,380.38 / $3,467.37
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$851.14 / $912.01 / $1,202.26
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $1,174.90
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,238.72 / $4,570.88
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,047.13 / $1,698.24