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Illinois rates for HCPCS 21076

Impression&Preparation Surg Obturator Prosthes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$694.96 / $1,549.66 / $1,824.53
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$655.32 / $844.68 / $1,549.66
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,038.23 / $14,506.03 / $31,639.49
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,207.92 / $2,656.71 / $3,162.75
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$754.02 / $841.77 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$788.83 / $1,148.94 / $1,791.99
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$923.92 / $1,355.46 / $3,054.77
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$857.92 / $904.57 / $1,197.33
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $1,353.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,095.00 / $2,588.00 / $4,780.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$832.23 / $1,146.85 / $1,921.72