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Tennessee rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.00 / $1,438.00 / $2,217.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$30.00 / $30.00 / $30.00
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $55.00 / $55.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,117.16 / $2,117.16 / $2,187.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$294.00 / $808.00 / $2,577.00