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Pennsylvania rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Facilitymedian $724 · 10th–90th $372–$4,2660%5%10th90th$724Professionalmedian $64,565 · 10th–90th $245–$64,5650%50%10th$64,565$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $245.47
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,258.93 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$54,954.09 / $64,565.42 / $64,565.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$354.81 / $676.08 / $3,890.45