go back

Arizona rates for HCPCS 21087

Impression and custom preparation; nasal prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,178.74 / $1,465.34 / $7,245.55
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.60 / $1,651.20 / $2,700.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,498.34 / $1,895.86 / $2,156.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,325.62 / $1,907.10 / $3,228.89
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,287.51 / $1,970.31 / $6,166.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,507.22 / $2,027.21 / $11,810.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,637.00 / $6,477.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,477.14 / $1,773.20 / $3,335.51