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Massachusetts rates for HCPCS 21080

Impression and custom preparation; definitive obturator prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,437.93 / $1,784.45 / $2,627.46
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,338.91 / $1,784.45 / $2,863.05
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,413.00 / $4,751.20 / $7,942.01
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,413.00 / $2,950.63 / $12,360.72
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,539.28 / $1,977.97 / $3,531.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,696.85 / $2,700.14 / $4,824.18
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $2,085.42 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,937.14 / $2,346.51 / $3,201.11
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,683.56 / $3,553.97 / $4,741.87
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,063.00 / $12,850.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,052.02 / $3,637.62 / $12,360.72
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $5,097.00 / $10,764.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,987.88 / $2,869.67 / $4,932.37