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Pennsylvania rates for HCPCS 21076

Impression&Preparation Surg Obturator Prosthes

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.15 / $715.15 / $876.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$657.16 / $836.09 / $1,249.20
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$883.04 / $916.37 / $916.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,228.44 / $1,228.44 / $1,228.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.16 / $1,048.53 / $1,743.41
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,031.11 / $1,367.65 / $1,781.02
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$715.15 / $715.15 / $876.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$684.05 / $876.80 / $2,604.09
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,152.90 / $1,152.90 / $2,054.69
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,228.44 / $1,228.44 / $1,228.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$747.16 / $1,060.08 / $1,798.73
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$692.55 / $790.78 / $970.06
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.55 / $820.49 / $886.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$814.00 / $2,391.00 / $4,789.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.26 / $1,133.68 / $1,815.24