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New Mexico rates for HCPCS 21087

Impression and custom preparation; nasal prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,316.49 / $1,316.49 / $1,614.23
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,316.49 / $1,614.23 / $3,314.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,496.30 / $2,282.56 / $3,027.36
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $269.43 / $2,245.30
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,425.79 / $2,040.36 / $2,658.40
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,659.57 / $2,394.07 / $3,388.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,817.53 / $2,477.80 / $3,859.64