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Montana rates for HCPCS 21088

Impression and custom preparation; facial prosthesis

Facilitymedian $5,888 · 10th–90th $4,365–$6,7610%50%10th90th$5,888Professionalmedian $4,266 · 10th–90th $1,738–$6,0260%20%10th90th$4,266$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $3,981.07 / $5,495.41
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,370.32 / $5,370.32 / $5,370.32
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$933.25 / $5,370.32 / $5,495.41
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,365.16 / $5,888.44 / $6,165.95
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,365.16 / $5,888.44 / $6,165.95
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $4,265.80 / $7,244.36
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$79.43 / $2,398.83 / $6,165.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,023.29 / $6,760.83
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $4,897.79 / $6,456.54