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Montana rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,310.19 / $4,380.72 / $4,380.72
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,411.53 / $5,411.53 / $5,411.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$927.37 / $5,411.53 / $5,411.53
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,714.75 / $2,714.75 / $5,411.53
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,983.64 / $4,475.92 / $6,456.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,855.67 / $5,013.72 / $5,734.61