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New Jersey rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,174.90 / $1,513.56
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $870.96 / $1,778.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,230.27 / $2,630.27
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,202.26 / $1,548.82
Horizon BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,090.30 / $4,786.30 / $7,585.78
Horizon BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $912.01 / $2,754.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $5,128.61 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $933.25 / $2,187.76