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Arizona rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $724.44 / $724.44
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $1,348.96 / $1,995.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $467.74 / $870.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,412.54 / $2,238.72
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,137.96 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $1,202.26 / $2,187.76