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Louisiana rates for HCPCS 21089

Unlisted Maxillofacial Prosthetic Procedure

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$230.22 / $415.73 / $669.42
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$400.00 / $400.00 / $400.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $543.00 / $1,560.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.72 / $138.72 / $141.58