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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
$1,202.26 / $1,621.81 / $3,630.78
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,187.76 / $5,248.07
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,398.83 / $4,073.80
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,778.28 / $2,238.72 / $3,162.28
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,238.72 / $4,168.69
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $2,137.96 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,290.87 / $4,265.80