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Utah rates for HCPCS 21087

Impression & Preparation Nasal Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,160.34 / $2,160.34 / $2,489.06
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.95 / $2,160.34 / $7,245.55
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,500.46 / $2,160.85 / $2,993.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.95 / $937.93 / $1,494.31
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,413.68 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,692.40 / $2,405.40 / $4,568.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,429.49 / $1,800.81 / $2,792.79