go back

Wisconsin rates for HCPCS 21087

Impression & Preparation Nasal Prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,265.77 / $1,558.73 / $5,913.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.77 / $1,558.73 / $6,441.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,538.00 / $9,948.00 / $15,579.70
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,582.61 / $2,741.49 / $8,356.77
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,183.17 / $2,183.17 / $2,183.17
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,141.55 / $4,839.72 / $7,424.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,986.34 / $4,650.76 / $6,900.54
DeanCare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,265.77 / $2,028.59 / $3,318.21
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,331.18 / $2,402.26 / $12,202.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,927.34 / $3,740.17 / $11,810.40
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$127.76 / $944.37 / $3,088.87
Prevea360
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,265.77 / $1,988.95 / $3,318.21
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,837.68 / $3,807.94 / $5,612.30
Quartz
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,383.77 / $1,383.77 / $5,903.87
Quartz
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,730.26 / $6,738.45 / $11,810.40
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,209.77 / $4,209.77 / $5,169.30
Security Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5,040.13 / $8,182.18 / $10,117.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,301.00 / $11,608.00 / $13,980.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,805.65 / $3,603.10 / $7,414.50