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Maryland rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.45 / $3,093.23 / $3,615.87
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$906.00 / $1,931.39 / $2,047.27
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.00 / $641.21 / $1,316.51
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,283.26 / $4,504.84 / $8,051.73
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,326.59 / $6,232.62 / $8,129.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$847.00 / $847.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,327.55 / $1,959.23 / $3,276.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,273.04 / $1,273.04 / $1,273.04