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North Carolina rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $1,548.82 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $891.25 / $1,995.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $1,230.27 / $2,344.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $602.56 / $602.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,258.93 / $2,137.96
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $1,737.80 / $1,995.26
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,096.48 / $1,778.28
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $1,737.80 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $3,467.37 / $6,606.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $977.24 / $1,778.28
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,365.16 / $4,365.16
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6,456.54 / $6,456.54 / $7,413.10