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Indiana rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,162.70 / $2,967.68 / $2,967.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$968.92 / $3,003.39 / $3,929.18
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$970.00 / $5,790.87 / $8,240.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$459.00 / $540.00 / $766.80
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,704.42 / $5,995.83 / $26,999.73
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,612.18 / $5,435.04 / $6,918.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,868.80 / $1,868.80 / $2,215.28
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$875.13 / $3,718.86 / $5,835.06
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,472.00 / $10,113.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,756.88 / $3,078.95 / $6,040.97