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Arizona rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $891.25 / $2,691.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,348.96 / $1,995.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,122.02 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $1,023.29 / $1,737.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $1,096.48 / $3,162.28
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,230.27 / $6,456.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $2,041.74 / $4,786.30
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $912.01 / $1,513.56