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South Dakota rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Facilitymedian $1,047 · 10th–90th $708–$1,9950%10%20%10th90th$1,047Professionalmedian $1,122 · 10th–90th $708–$2,0890%10%10th90th$1,122$1.0K$2.0K$5.0K

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 / $758.58 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$645.65 / $870.96 / $1,698.24
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,479.11 / $2,089.30 / $2,630.27
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,380.38 / $2,238.72
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$891.25 / $2,089.30 / $6,456.54
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,819.70 / $2,187.76
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,548.82 / $1,819.70 / $2,187.76
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,071.52 / $1,479.11 / $1,737.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $3,162.28
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,412.54 / $2,454.71
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,698.24 / $2,089.30