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Pennsylvania rates for HCPCS 21081

Impression and custom preparation; mandibular resection prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,171.52 / $1,474.52 / $2,489.92
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,545.50 / $1,603.82 / $1,603.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.67 / $1,818.37 / $3,079.58
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,807.04 / $2,395.56 / $3,121.24
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,193.58 / $1,570.69 / $3,665.63
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,031.60 / $2,031.60 / $3,611.60
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,271.67 / $1,838.32 / $3,146.23
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.69 / $1,459.30 / $1,577.36
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,490.92 / $1,923.97 / $3,186.98