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Massachusetts rates for HCPCS 21195

Reconstruction of mandibular rami and/or body, sagittal split; without internal rigid fixation

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,528.00 / $2,894.00 / $6,107.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,208.09 / $1,355.57 / $2,146.76
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,472.59 / $4,751.20 / $11,028.78
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,294.81 / $2,285.08 / $14,575.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,325.82 / $2,182.46 / $3,955.34
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$300.00 / $2,108.05 / $8,090.00
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,531.01 / $1,854.55 / $2,533.82
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,644.95 / $3,260.95 / $4,301.71
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $5,063.00 / $13,773.00
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,447.37 / $2,484.46 / $14,575.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,324.00 / $6,204.00 / $13,284.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,426.98 / $2,054.71 / $3,909.62