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Massachusetts rates for HCPCS 21100

Application of halo type appliance for maxillofacial fixation, includes removal (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $2,818.38 / $5,128.61
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $616.60 / $1,202.26
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $7,079.46 / $28,840.32
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $758.58 / $1,905.46
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$436.52 / $436.52 / $1,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $831.76 / $1,621.81
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $741.31 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $912.01 / $1,318.26
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
$398.11 / $758.58 / $1,621.81
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $7,079.46 / $28,840.32
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.11 / $758.58 / $1,905.46
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
$407.38 / $794.33 / $1,659.59