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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
$921.69 / $1,097.11 / $1,636.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.25 / $1,097.11 / $1,460.06
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,350.12 / $3,006.60 / $6,579.11
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.36 / $1,107.67 / $1,573.02
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $40.00 / $619.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$772.26 / $1,146.00 / $1,617.31
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$470.00 / $1,429.00 / $4,123.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.75 / $1,059.51 / $1,727.30