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Utah rates for HCPCS 21088

Impression and custom preparation; facial prosthesis

Facilitymedian $4,677 · 10th–90th $955–$9,5500%20%40%10th90th$4,677Professionalmedian $3,236 · 10th–90th $955–$6,3100%10%10th90th$3,236$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. Small sample — interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$954.99 / $954.99 / $954.99
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $3,162.28 / $6,309.57
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,951.21 / $4,570.88 / $7,244.36
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$30.20 / $44.67 / $60.26
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,677.35 / $6,309.57 / $9,772.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$758.58 / $4,786.30 / $7,762.47
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,786.30 / $5,011.87 / $6,165.95
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,951.21 / $5,011.87