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Minnesota rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $870.96 / $870.96
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,380.38
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,786.30 / $10,964.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,862.09 / $3,019.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $3,162.28 / $7,585.78
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,398.83 / $3,715.35
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,019.95 / $6,025.60
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,238.72 / $3,548.13
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,445.44 / $2,511.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,862.09 / $5,248.07
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $3,715.35 / $6,456.54
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,548.82 / $2,884.03