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Pennsylvania rates for HCPCS 21089

Unlisted Maxillofacial Prosthetic Procedure

Insurance Carrier
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,083.51 / $1,395.00 / $12,759.45
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,249.45 / $64,999.35 / $64,999.35
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,117.16 / $2,117.16 / $2,117.16
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$55,249.45 / $55,249.45 / $55,249.45
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,293.50 / $6,293.50 / $6,293.50
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,117.16 / $2,117.16 / $2,117.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $650.00 / $3,742.00