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Maine rates for HCPCS 21087

Impression and custom preparation; nasal prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,737.80 / $3,548.13
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,905.46 / $3,090.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $2,238.72 / $3,630.78
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,041.74 / $3,981.07
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,445.44 / $2,137.96 / $4,897.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,041.74 / $3,388.44