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Indiana rates for HCPCS 21080

Impression and custom preparation; definitive obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,256.14 / $1,570.10 / $2,611.19
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.61 / $1,533.21 / $2,054.64
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,153.00 / $5,790.87 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,312.26 / $2,163.02 / $2,920.07
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,225.08 / $1,592.60 / $2,064.04
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,545.09 / $1,776.85 / $2,317.64
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,012.65 / $1,012.65 / $1,200.39
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,481.31 / $2,080.71 / $3,596.65
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,492.93 / $1,978.58 / $3,449.36