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Nebraska rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,904.09 / $2,904.09 / $2,904.09
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,904.09 / $2,904.09 / $5,048.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,271.26 / $4,302.59 / $8,322.61
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,927.57 / $4,990.17 / $6,653.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,091.67 / $2,091.67 / $2,091.67
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,140.74 / $6,201.96 / $9,221.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,904.09 / $5,048.50 / $9,009.96
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,488.46 / $5,278.73 / $8,139.74
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,176.17 / $4,986.49 / $8,302.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,853.12 / $6,553.40 / $9,221.45
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,178.00 / $7,441.00 / $8,816.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,683.46 / $6,487.74 / $7,668.80