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Pennsylvania rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Facilitymedian $871 · 10th–90th $708$5,2480%20%10th90th$871Professionalmedian $871 · 10th–90th $661$1,5140%20%10th90th$871$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
$707.95 / $707.95 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$660.69 / $851.14 / $1,380.38
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,456.54 / $7,585.78 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,000.00 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$724.44 / $1,071.52 / $1,737.80
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $1,479.11 / $1,905.46
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,202.26 / $1,949.84
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $707.95 / $870.96
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $851.14 / $1,380.38
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,548.82 / $2,137.96
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $691.83 / $977.24
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $691.83 / $891.25
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $2,818.38 / $5,495.41
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $954.99 / $1,621.81