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Illinois rates for HCPCS 21089

Unlisted Maxillofacial Prosthetic Procedure

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$278.38 / $332.12 / $428.46
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$9,999.99 / $9,999.99 / $9,999.99
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $345.40 / $345.40
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
$1,500.00 / $2,500.00 / $2,500.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $891.00 / $3,685.00