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Ohio rates for HCPCS 21088

Impression and custom preparation; facial prosthesis

Facilitymedian $3,631 · 10th–90th $1,349$7,9430%5%10%10th90th$3,631Professionalmedian $2,455 · 10th–90th $550$4,2660%10%10th90th$2,455$50.0$200.0$1.0K$5.0K$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
Facility
Modifier
Typical Low / Median / Typical High
$3,311.31 / $3,630.78 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $3,090.30 / $4,365.16
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $3,019.95 / $7,943.28
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $660.69 / $1,096.48
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,370.32 / $5,370.32 / $6,309.57
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $5,011.87 / $7,585.78
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,884.03 / $5,011.87 / $7,413.10
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $50.12 / $60.26
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $4,073.80
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$50.12 / $70.79 / $75.86
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $6,606.93 / $10,471.29
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,778.28 / $2,951.21 / $5,754.40