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Montana rates for HCPCS 21087

Impression & Preparation Nasal Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,332.91 / $2,259.62 / $8,840.10
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,008.56 / $2,008.56 / $2,008.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,260.19 / $2,106.39 / $3,098.07
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,007.86 / $1,553.53 / $2,498.75
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,460.60 / $2,242.09 / $3,218.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,266.44 / $2,811.35 / $3,105.32