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Rhode Island rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.47 / $245.47 / $245.47
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $380.19 / $524.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $1,412.54 / $6,456.54