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Nebraska rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.24 / $805.65 / $2,064.03
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.24 / $805.65 / $3,959.30
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,271.26 / $4,302.59 / $8,322.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$695.36 / $1,198.47 / $1,649.71
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$581.27 / $581.27 / $581.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,378.46 / $1,790.37 / $2,633.17
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$744.01 / $1,329.32 / $2,467.73
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,126.35 / $1,910.48 / $5,296.88
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$639.39 / $1,785.00 / $2,355.30
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,514.15 / $1,945.40 / $2,324.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,044.00 / $3,726.00 / $7,934.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,027.80 / $1,686.56 / $2,285.64