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South Carolina rates for HCPCS 21088

Impression and custom preparation; facial prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $3,630.78 / $3,630.78
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $3,019.95 / $4,365.16
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,623.41 / $9,772.37 / $17,378.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $2,290.87 / $9,549.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $4,365.16 / $7,943.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $3,630.78 / $6,606.93
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.20 / $30.20 / $30.20
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,630.78 / $16,982.44 / $25,703.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,951.21 / $4,677.35