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Wyoming rates for HCPCS 21076

Impression and custom preparation; surgical obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$713.40 / $889.88 / $1,117.79
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,304.00 / $1,304.00 / $1,304.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,345.00 / $1,657.00 / $2,507.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,157.17 / $1,512.03 / $2,418.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,275.00 / $1,275.00 / $5,606.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.81 / $1,803.31 / $3,217.48