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Tennessee rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.83 / $1,420.03 / $1,946.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$652.83 / $865.87 / $1,380.59
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,270.00 / $2,181.00 / $3,084.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$819.30 / $1,161.34 / $1,788.06
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$814.02 / $1,185.96 / $1,881.56
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $3,545.12 / $3,545.12
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,271.28 / $6,495.04 / $7,393.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,130.00 / $2,297.00 / $4,099.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.21 / $1,091.07 / $1,898.70