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Massachusetts rates for HCPCS 21145

Reconstruction midface, LeFort I; single piece, segment movement in any direction, requiring bone grafts (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,949.84 / $3,630.78 / $5,370.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,819.70 / $5,128.61
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,897.79 / $14,125.38
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,344.23 / $13,803.84
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,380.38 / $2,344.23 / $4,265.80
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $2,344.23 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $1,949.84 / $2,754.23
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
$1,412.54 / $2,570.40 / $3,801.89
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $4,897.79 / $14,125.38
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,344.23 / $13,803.84
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 / $2,290.87 / $4,265.80