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Connecticut rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,258.93 / $1,348.96 / $1,659.59
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $912.01 / $2,137.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,715.35 / $4,168.69 / $12,022.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,513.56 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $851.14 / $1,071.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,548.82 / $2,344.23
ConnectiCare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,479.11 / $1,862.09
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $5,495.41 / $9,332.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,258.93 / $2,290.87