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North Carolina rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$606.10 / $606.10 / $606.10
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$462.00 / $462.00 / $462.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$117.00 / $896.00 / $2,229.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $55.00
Wellcare
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,487.65 / $1,487.65 / $2,187.02