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Illinois rates for HCPCS 21088

Impression and custom preparation; facial prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,311.31 / $3,311.31 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $3,019.95 / $5,495.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $5,011.87 / $11,220.18
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,691.53 / $2,691.53 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,951.21 / $5,623.41 / $7,585.78
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $870.96 / $5,888.44
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $645.65 / $707.95
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $5,370.32 / $12,302.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $3,235.94 / $6,456.54