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Montana rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,122.02 / $2,238.72
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,348.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $1,096.48
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,148.15 / $1,412.54
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,479.11 / $1,659.59
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,479.11 / $1,659.59
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,230.27 / $1,778.28
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $1,174.90 / $1,778.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $1,659.59