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New Hampshire rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$804.30 / $1,103.45 / $4,060.93
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $3,700.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,604.39 / $1,604.39 / $1,738.52
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,181.37 / $5,181.37 / $5,181.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,336.18 / $6,491.57 / $9,334.94
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,794.27 / $7,542.35 / $14,797.51
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,155.00 / $11,155.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,156.42 / $4,313.66 / $9,726.70
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,500.00 / $2,750.00 / $3,500.00