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Massachusetts rates for HCPCS 21087

Impression and custom preparation; nasal prosthesis

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,445.44 / $1,778.28 / $1,778.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $1,737.80 / $3,715.35
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,168.69 / $12,882.50
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,290.87 / $5,128.61
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,479.11 / $1,479.11 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $2,570.40 / $4,168.69
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $1,862.09 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,819.70 / $2,290.87 / $3,235.94
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,344.23 / $4,265.80
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,168.69 / $12,882.50
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $2,290.87 / $5,128.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,511.89 / $6,309.57 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,398.83 / $4,365.16