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Massachusetts rates for HCPCS 21188

Reconstruction midface, osteotomies (other than LeFort type) and 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
$1,445.44 / $1,659.59 / $4,265.80
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,011.87 / $14,454.40
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,398.83 / $15,488.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $2,454.71 / $4,365.16
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$302.00 / $2,344.23 / $8,511.38
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,584.89 / $1,995.26 / $2,818.38
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
$1,479.11 / $2,630.27 / $3,890.45
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $5,011.87 / $14,454.40
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,479.11 / $2,398.83 / $15,488.17
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
$1,621.81 / $2,398.83 / $4,466.84