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Custom Artificial Nose Prosthesis

Montana rates for HCPCS 21087

Taking an impression and custom-building an artificial nose for someone who has lost part or all of the nose to injury, disease, or surgery. The prosthesis is sculpted and colored to blend with the surrounding face and is made to be put on and taken off by the wearer.

Rates data updated July 2026.

Facilitymedian $2,630 · 10th–90th $2,188$3,1620%20%10th90th$2,630Professionalmedian $2,239 · 10th–90th $1,318$3,7150%10%10th90th$2,239$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,819.70
Typical High
$6,918.31
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$1,995.26
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$2,089.30
Typical High
$3,090.30
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,691.53
Typical High
$3,090.30
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$2,187.76
Median
$2,691.53
Typical High
$3,090.30
Providence
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$2,290.87
Typical High
$3,235.94
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$2,137.96
Typical High
$3,162.28
United
Setting
Facility
Modifier
Global
Typical Low
$2,089.30
Median
$2,089.30
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$2,511.89
Typical High
$3,162.28