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Michigan rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,110.04 / $4,110.04 / $4,268.12
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.45 / $3,303.47 / $4,268.12
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,379.71 / $4,113.39 / $6,275.55
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.29 / $1,584.29 / $4,110.04
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.29 / $1,686.09 / $4,110.04
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $30.00 / $55.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,652.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,917.14 / $2,898.85 / $4,316.27