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Ohio rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Facilitymedian $2,089 · 10th–90th $776$4,5710%10%20%10th90th$2,089Professionalmedian $891 · 10th–90th $692$1,4450%20%10th90th$891$10.0$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
$758.58 / $1,348.96 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $870.96 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $3,019.95 / $7,943.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $977.24 / $1,513.56
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $1,174.90 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$741.31 / $1,122.02 / $1,737.80
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $1,122.02 / $1,698.24
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $616.60
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $1,905.46
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $933.25 / $1,513.56
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $2,691.53 / $5,248.07
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$616.60 / $954.99 / $1,479.11