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Massachusetts rates for HCPCS 21081

Impression and custom preparation; mandibular resection prosthesis

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,225.77 / $1,652.45 / $2,641.74
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,297.92 / $2,710.32 / $11,382.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,553.59 / $2,475.42 / $4,449.60
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,784.99 / $2,162.21 / $2,951.13
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,543.33 / $3,265.84 / $4,469.31
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,863.77 / $3,353.56 / $11,382.08
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,717.67 / $2,466.98 / $4,516.00