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Oklahoma rates for HCPCS 21087

Impression and custom preparation; nasal prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,366.07 / $1,366.07 / $1,653.82
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,312.90 / $1,366.07 / $1,653.82
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,085.68 / $1,085.68 / $1,085.68
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.64 / $2,015.63 / $2,943.80
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,366.07 / $2,111.73 / $6,026.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,461.72 / $2,002.38 / $11,810.40
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,524.00 / $9,232.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,392.96 / $1,828.26 / $2,481.21