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Virginia 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
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.96 / $2,570.40 / $2,951.21
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $1,995.26 / $2,754.23
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$645.65 / $645.65 / $645.65
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $1,479.11 / $10,964.78
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,479.11 / $10,964.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$218.78 / $1,148.15 / $2,398.83