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Pennsylvania rates for HCPCS 21087

Impression and custom preparation; nasal prosthesis

Facilitymedian $1,585 · 10th–90th $1,288$15,8490%10%20%10th90th$1,585Professionalmedian $1,585 · 10th–90th $1,230$2,7540%10%10th90th$1,585$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,584.89
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,584.89 / $2,511.89
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $1,659.59 / $2,818.38
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $1,949.84 / $3,162.28
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,905.46 / $2,630.27 / $3,311.31
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,137.96 / $3,548.13
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,288.25 / $1,288.25 / $1,584.89
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,548.82 / $2,187.76
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,238.72 / $2,884.03 / $3,981.07
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $1,258.93 / $2,290.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $1,258.93 / $1,548.82
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,344.23 / $5,754.40 / $19,054.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,778.28 / $3,019.95