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Wisconsin rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Facilitymedian $4,266 · 10th–90th $1,288$7,4130%10%10th90th$4,266Professionalmedian $1,122 · 10th–90th $692$3,3880%10%10th90th$1,122$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
$691.83 / $1,479.11 / $1,862.09
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$691.83 / $851.14 / $1,905.46
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,311.31 / $4,786.30 / $7,585.78
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $1,445.44 / $3,801.89
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,691.53 / $4,265.80
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $2,137.96 / $4,073.80
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,412.54 / $3,311.31
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,819.70 / $2,691.53
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,479.11 / $4,786.30
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$977.24 / $1,949.84 / $6,456.54
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $1,096.48
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $3,890.45 / $4,570.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,096.48 / $2,344.23 / $3,388.44
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $2,041.74 / $3,162.28
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$794.33 / $1,862.09 / $4,365.16
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $4,466.84 / $6,456.54
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,290.87 / $2,290.87 / $2,818.38
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $4,466.84 / $5,623.41
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $3,548.13 / $6,606.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$870.96 / $1,380.38 / $3,467.37