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Massachusetts rates for HCPCS 21195

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

Facilitymedian $3,631 · 10th–90th $1,514–$6,9180%10%10th90th$3,631Professionalmedian $1,660 · 10th–90th $1,230–$3,6310%10%20%10th90th$1,660$100.0$500.0$2.0K$10.0K$50.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,715.35 / $6,456.54
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,380.38 / $3,388.44
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $4,466.84 / $15,135.61
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $2,041.74 / $15,135.61
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,995.26 / $3,981.07
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,737.80 / $3,630.78
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,659.59 / $2,344.23
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,019.95 / $6,165.95 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $2,344.23 / $3,715.35
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $4,466.84 / $15,135.61
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $2,041.74 / $15,135.61
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $5,888.44 / $13,803.84
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,089.30 / $3,890.45