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Illinois rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $338.84 / $416.87
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10,000.00 / $10,000.00 / $10,000.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $199.53 / $346.74
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,513.56 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $724.44 / $2,187.76