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Pennsylvania rates for HCPCS 21080

Impression and custom preparation; definitive obturator prosthesis

Facilitymedian $1,698 · 10th–90th $1,349–$10,2330%20%10th90th$1,698Professionalmedian $1,660 · 10th–90th $1,259–$2,8840%10%20%10th90th$1,660$100.0$500.0$2.0K$10.0K$50.0K

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
$1,348.96 / $1,348.96 / $1,698.24
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,621.81 / $2,691.53
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $1,862.09 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,995.26 / $3,311.31
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,041.74 / $2,754.23 / $3,548.13
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $2,238.72 / $3,630.78
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,348.96 / $1,698.24
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $1,621.81 / $2,454.71
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $3,019.95 / $4,265.80
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $1,288.25 / $2,290.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $1,318.26 / $1,659.59
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,370.32 / $10,964.78
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,819.70 / $3,090.30