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Massachusetts rates for HCPCS 21151

Reconstruction midface, LeFort II; 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 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,621.81 / $2,089.30 / $4,677.35
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,011.87 / $16,595.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,818.38 / $18,197.01
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,884.03 / $5,011.87
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $2,511.89 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,737.80 / $2,187.76 / $3,019.95
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
$1,584.89 / $2,884.03 / $4,265.80
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,011.87 / $16,595.87
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,698.24 / $2,818.38 / $18,197.01
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
$1,862.09 / $2,818.38 / $4,897.79