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Custom-Made Facial Prosthesis

Nevada rates for HCPCS 21088

Taking an impression of the face and custom-building an artificial replacement for a part of the face that has been lost through injury, cancer surgery, or a difference present from birth. The prosthesis is sculpted and colored to match the surrounding skin so it blends in, then fitted and adjusted until it sits correctly.

Rates data updated July 2026.

Facilitymedian $3,802 · 10th–90th $2,570$5,8880%20%10th90th$3,802Professionalmedian $3,020 · 10th–90th $955$4,1690%20%10th90th$3,020$10.0$50.0$200.0$1.0K$5.0K

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
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$3,019.95
Typical High
$3,019.95
Aetna
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$3,019.95
Typical High
$3,890.45
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,801.89
Median
$4,073.80
Typical High
$5,888.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$3,235.94
Typical High
$5,370.32
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,479.11
Median
$1,479.11
Typical High
$1,479.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$3,801.89
Typical High
$7,585.78
Hometown Health
Setting
Professional
Modifier
Global
Typical Low
$6.46
Median
$7.41
Typical High
$831.76
Hometown Health
Setting
Professional
Modifier
Global
Typical Low
$5.50
Median
$5.50
Typical High
$5.50
Select Health
Setting
Professional
Modifier
Global
Typical Low
$5,011.87
Median
$5,011.87
Typical High
$5,128.61
United
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$3,548.13
Typical High
$10,715.19
United
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$2,570.40
Typical High
$6,025.60