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West Virginia rates for HCPCS 21087

Impression and custom preparation; nasal prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,265.17 / $1,519.92 / $2,380.67
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,265.17 / $1,614.85 / $2,795.48
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,274.96 / $1,386.31 / $1,666.90
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$916.06 / $1,481.69 / $1,481.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,222.92 / $2,222.92 / $2,222.92
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,372.65 / $2,306.27 / $5,301.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,305.71 / $2,041.71 / $3,025.18