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Washington rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Facilitymedian $692 · 10th–90th $214–$1,3490%10%10th90th$692Professionalmedian $229 · 10th–90th $45–$2450%50%10th90th$229$50.0$100.0$200.0$500.0$1.0K$2.0K$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
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $645.65 / $1,318.26
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $229.09
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $758.58 / $870.96
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $676.08 / $977.24
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
$83.18 / $234.42 / $588.84
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$426.58 / $676.08 / $1,318.26
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $117.49 / $229.09
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$218.78 / $812.83 / $1,905.46