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Louisiana rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $416.87 / $660.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $501.19 / $1,202.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $138.04 / $141.25