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Virginia rates for HCPCS 21089

Unlisted maxillofacial prosthetic procedure

Insurance Carrier
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,735.00 / $2,390.00 / $2,954.00
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.00 / $1,757.00 / $2,413.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$640.00 / $640.00 / $640.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,117.16 / $2,117.16 / $2,117.16
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$805.00 / $1,291.00 / $9,929.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$805.00 / $1,291.00 / $9,929.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$231.00 / $1,045.00 / $2,364.00