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New Hampshire rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,951.21 / $2,951.21 / $3,388.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $954.99 / $1,584.89
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $1,737.80 / $3,019.95
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $1,174.90 / $1,659.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,479.11 / $2,630.27
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,288.25 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,709.64 / $8,709.64 / $8,709.64
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,318.26 / $2,290.87
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $1,047.13