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Utah rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$961.45 / $961.45 / $961.45
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.45 / $2,858.20 / $6,296.73
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,929.25 / $4,871.84 / $7,305.24
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$30.00 / $45.00 / $60.00
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,525.68 / $6,104.56 / $8,896.10
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$771.31 / $4,976.18 / $7,496.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,663.27 / $3,166.81 / $5,338.32