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Indiana rates for HCPCS L8049

Repair or modification of maxillofacial prosthesis, labor component, 15 minute increments, provided by a nonphysician

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$28.36 / $28.36 / $28.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$28.36 / $28.36 / $55.00
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$25.00 / $25.00 / $48.25
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14.60 / $25.00 / $33.00
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$27.78 / $27.78 / $40.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$21.61 / $31.95 / $38.90
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12.60 / $12.60 / $12.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$10.71 / $12.60 / $12.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$8.83 / $13.25 / $22.08