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Utah rates for HCPCS 21080

Impression and custom preparation; definitive obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,187.76 / $2,630.27
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,905.46 / $7,943.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,137.96 / $3,467.37
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $3,090.30
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $5,370.32 / $12,022.64
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,818.38 / $4,677.35
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,570.40 / $3,467.37
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,344.23 / $3,715.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,737.80 / $2,754.23