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Idaho rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.45 / $3,999.55 / $6,296.73
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,674.04 / $1,674.04 / $1,678.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,438.95 / $4,871.84 / $5,445.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,469.59 / $5,352.22 / $7,619.04
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,148.78 / $2,148.78 / $2,343.65
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $2,000.00 / $3,900.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,803.94 / $7,766.93 / $9,755.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,976.18 / $6,531.17 / $6,859.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,753.04 / $4,292.39 / $6,056.71