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New Hampshire rates for HCPCS 21088

Impression and custom preparation; facial prosthesis

Facilitymedian $1,778 · 10th–90th $1,585–$4,8980%20%10th90th$1,778Professionalmedian $4,266 · 10th–90th $977–$11,7490%5%10%10th90th$4,266$500.0$1.0K$2.0K$5.0K$10.0K$20.0K

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 / $1,122.02 / $4,073.80
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,513.56 / $1,737.80 / $3,890.45
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,621.81 / $1,621.81 / $1,621.81
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $6,456.54 / $10,232.93
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11,220.18 / $11,220.18 / $11,220.18
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$6,165.95 / $8,709.64 / $12,882.50
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$11,220.18 / $11,220.18 / $11,220.18
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $6,309.57 / $12,589.25
Well Sense
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,630.78 / $4,073.80 / $5,754.40