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Louisiana rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $1,096.48 / $1,148.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $912.01 / $1,445.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $3,019.95 / $6,606.93
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,096.48 / $1,380.38
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,148.15 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,479.11 / $3,981.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $954.99 / $1,584.89