go back

Washington rates for HCPCS 21088

Impression & Preparation Facial Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,999.55 / $3,999.55 / $3,999.55
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$961.45 / $3,999.55 / $4,380.72
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,412.73 / $9,101.25 / $17,812.14
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,502.75 / $7,385.05 / $30,035.78
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.97 / $870.49 / $3,302.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,398.52 / $6,903.78 / $10,417.01
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,225.36 / $4,629.77 / $8,266.54
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,225.36 / $4,506.59 / $7,677.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$45.00 / $50.00 / $75.00
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,137.38 / $5,861.29 / $6,895.64
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.50 / $4,178.02 / $4,703.43
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,787.96 / $7,287.77 / $9,335.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,812.14 / $9,118.81 / $17,453.22
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,261.03 / $6,378.01 / $8,677.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $4,016.00 / $16,315.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,476.71 / $5,157.35 / $9,151.34
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,738.52 / $1,738.52 / $1,738.52