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California rates for HCPCS 21089

Unlisted Maxillofacial Prosthetic Procedure

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$248.00 / $248.00 / $248.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,645.00 / $4,604.00 / $6,240.00
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.80 / $100.00 / $7,100.20
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,277.00 / $2,277.00 / $2,277.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$393.93 / $638.07 / $801.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $55.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,487.65 / $2,117.16 / $2,187.02
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.00 / $70.00 / $85.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,277.00 / $2,277.00 / $2,277.00
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,117.16 / $2,117.16 / $2,117.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$587.00 / $1,551.00 / $6,323.00