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Indiana 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
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $4,466.84 / $8,709.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$0.02 / $0.02 / $0.02
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$60,255.96 / $74,131.02 / $75,857.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.98 / $2,137.96 / $5,754.40