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Indiana rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,023.29 / $1,479.11
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $851.14 / $1,380.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $8,709.64 / $11,220.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,288.25 / $1,995.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$794.33 / $1,258.93 / $2,041.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,023.29 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $3,715.35 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $954.99 / $1,659.59