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Washington rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Facilitymedian $1,585 · 10th–90th $871$2,6300%10%10th90th$1,585Professionalmedian $1,175 · 10th–90th $708$2,0890%10%10th90th$1,175$50.0$200.0$1.0K$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
$1,122.02 / $1,659.59 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$707.95 / $977.24 / $1,949.84
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $4,265.80 / $8,317.64
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,000.00 / $1,513.56 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $870.96 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$831.76 / $1,412.54 / $2,398.83
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,348.96 / $2,238.72
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$794.33 / $1,348.96 / $2,137.96
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $371.54
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,737.80 / $1,905.46
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,148.15 / $1,174.90
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,380.38 / $2,137.96
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,162.28 / $4,265.80 / $8,317.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $1,513.56 / $2,137.96
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,380.38 / $4,786.30 / $8,912.51
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$912.01 / $1,288.25 / $2,137.96
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$676.08 / $1,023.29 / $1,318.26