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Missouri rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.75 / $2,714.75 / $5,090.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,714.75 / $3,246.55 / $3,577.09
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,278.81 / $2,634.37 / $5,328.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,848.92 / $4,189.59 / $6,505.88
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $8,984.89
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,239.37 / $4,009.49 / $25,045.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,156.00 / $4,000.00 / $10,781.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,090.69 / $3,690.46 / $6,422.93