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Washington rates for HCPCS 21088

Impression and custom preparation; facial prosthesis

Facilitymedian $6,918 · 10th–90th $2,692–$11,4820%10%10th90th$6,918Professionalmedian $3,981 · 10th–90th $955–$7,7620%10%10th90th$3,981$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
$3,981.07 / $3,981.07 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$954.99 / $3,090.30 / $5,495.41
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,495.41 / $8,912.51 / $17,378.01
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $6,309.57 / $8,709.64
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $870.96 / $3,981.07
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$3,890.45 / $7,079.46 / $10,471.29
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $6,309.57 / $10,964.78
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,398.83 / $5,888.44 / $8,317.64
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$44.67 / $50.12 / $64.57
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,786.30 / $6,918.31 / $6,918.31
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,398.83 / $4,168.69 / $4,677.35
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,677.35 / $6,918.31 / $10,715.19
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$6,606.93 / $9,120.11 / $17,378.01
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$4,265.80 / $6,309.57 / $8,511.38
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,090.30 / $10,471.29 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,344.23 / $4,466.84 / $8,317.64
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,737.80 / $1,737.80 / $1,737.80