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South Dakota rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,166.32 / $3,166.32 / $3,166.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,826.93 / $3,166.32 / $5,023.97
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,307.07 / $3,639.18 / $4,548.97
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,857.11 / $4,777.51 / $6,553.40
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,108.26 / $4,392.20 / $25,045.36
Midlands
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,308.06 / $6,098.07 / $8,302.87
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,420.77 / $6,201.96 / $8,404.93
Sanford Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$888.94 / $888.94 / $888.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,500.00 / $4,500.00 / $4,500.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,283.94 / $4,392.20 / $8,573.40
Wellmark
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,015.20 / $1,242.20 / $1,242.20