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Maryland rates for HCPCS 21081

Impression and custom preparation; mandibular resection prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,548.82 / $3,981.07
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,318.26 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,905.46 / $3,388.44
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $1,905.46 / $2,818.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.15 / $1,778.28 / $3,019.95
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,258.93 / $1,995.26 / $2,398.83