Musculoskeletal Surgery · 21246

Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal)

What Medicare pays for 21246, what providers bill, and how the price varies across 0 states, drawn from CMS 2023 claims data.

21246 · the short answer

For complete reconstruction of lower or upper jaw bone with jaw bone implant (subperiosteal), Medicare pays about $302.49 while providers bill $3,539.04 on average, a 11.7× markup, one of the steepest markups in the catalog.

Medicare pays
$302.49
Providers bill
$3,539.04
Markup
11.7×
Markup percentile
93th

Medicare amounts are CMS-published; markup = average submitted charge ÷ average Medicare payment.

Medicare Payment (avg)
$302.49
What Medicare actually pays
Billed Charge (avg)
$3,539.04
What providers submit
Markup
11.7x
1070% above Medicare rate
18
Total Services
16
Beneficiaries
14
Providers
0
States with Data

What You Might Pay

Est. Commercial Insurance
$848.50
Range: $593.95 – $1,187.89
Est. Cash / Self-Pay
$1,257.33
Typical self-pay discount

Estimated using RAND 2024 commercial-to-Medicare ratios. Actual prices vary by insurer, plan, and facility.

How we estimate these prices

These estimates are based on the RAND Hospital Price Transparency Study (4th Edition, 2024), which found that commercial insurance prices average 224% of Medicare rates nationally. We apply category-specific ratios: Musculoskeletal Surgery procedures average 2.24x Medicare rates. Cash/self-pay estimates blend typical cash discounts (55% of billed charges) with Medicare-based estimates (150% of allowed amounts). These are statistical estimates, not quotes. Contact your insurer or provider for actual costs.

Where this markup sits nationally

Markup (billed ÷ Medicare) across 8,901 procedures with a meaningful Medicare rate

12 Among the most affordable more affordable than 93% of 8,901 procedures

1–2: 466 procedures (5%). Below this entry. 2–3: 681 procedures (8%). Below this entry. 3–4: 845 procedures (9%). Below this entry. 4–5: 1,308 procedures (15%). Below this entry. 5–6: 1,725 procedures (19%). Below this entry. 6–7: 1,217 procedures (14%). Below this entry. 7–8: 801 procedures (9%). Below this entry. 8–9: 541 procedures (6%). Below this entry. 9–10: 351 procedures (4%). Below this entry. 10–11: 246 procedures (3%). Below this entry. 11–12: 151 procedures (2%). This entry sits in this band. 12–13: 175 procedures (2%). Above this entry. 13–14: 140 procedures (2%). Above this entry. 14–15: 40 procedures (0%). Above this entry. 15–16: 39 procedures (0%). Above this entry. 16–17: 26 procedures (0%). Above this entry. 17–18: 25 procedures (0%). Above this entry. 18–19: 21 procedures (0%). Above this entry. 19–20: 12 procedures (0%). Above this entry. 20–21: 16 procedures (0%). Above this entry. 21–22: 13 procedures (0%). Above this entry. 22–23: 8 procedures (0%). Above this entry. 23–24: 9 procedures (0%). Above this entry. 24–25: 4 procedures (0%). Above this entry. 25–26: 3 procedures (0%). Above this entry. 26–27: 3 procedures (0%). Above this entry. 27–28: 4 procedures (0%). Above this entry. 28–29: 3 procedures (0%). Above this entry. 29–30: 2 procedures (0%). Above this entry. 30–31: 26 procedures (0%). Above this entry. this procedure 1 31 × markup, bucketed by value

Each bar is a band; taller bars hold more procedures. The dashed line + filled bar mark this entry. Hover or tap any bar for its full count, share, and where it sits relative to this entry.

Source CMS Medicare Physician & Other Practitioners · 2023

What the Data Says About Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal)

Across 0 states with reporting providers, CPT code 21246 (Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal)) shows a national average Medicare payment of $302.49 against an average billed charge of $3,539.04. That gap, a 11.7x markup, or 1070% above the Medicare allowed amount, sits among the widest billed-to-paid spreads we track, the kind of chargemaster pricing almost no payer, insured or cash, actually honors in full.

Musculoskeletal Surgery procedures like this one saw 18 services billed to Medicare in 2023 by 14 distinct providers, serving 16 unique beneficiaries. Regional variation is limited in the underlying CMS file. Where state-level figures exist for complete reconstruction of lower or upper jaw bone with jaw bone implant (subperiosteal), Geographic Practice Cost Indices (GPCIs), local malpractice premiums, and practice-expense adjustments are the usual drivers of any difference.

Applying RAND 2024 commercial-to-Medicare ratios specific to the Musculoskeletal Surgery category (2.24x), the estimated commercial insurance price lands near $848.50, with self-pay cash discounts commonly bringing the figure closer to $1,257.33. Within Musculoskeletal Surgery, Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal) ranks #953 of 1411 tracked procedures by national average Medicare payment.

What to do with this

If you may have complete reconstruction of lower or upper jaw bone with jaw bone implant (subperiosteal) done, these steps turn the numbers above into a real-world cost estimate.

  • Request a Good Faith Estimate from your provider at least 3 business days before a scheduled procedure, under the No Surprises Act it is an enforceable written price.
  • Compare complete reconstruction of lower or upper jaw bone with jaw bone implant (subperiosteal) costs in your state, Medicare rates vary by locality. Browse states
  • Check a hospital’s published cash price, which is often far below the billed charge. Price transparency
  • Understand why billed charges run several times the Medicare rate before you negotiate. Read the guide

Figures here are averages and estimates, not a quote. Confirm coverage and out-of-pocket costs with your insurer and provider.

Frequently Asked Questions

How much does Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal) cost?

The national average Medicare payment for Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal) (CPT 21246) is $302.49, while providers typically bill $3,539.04.

Why do providers charge more than Medicare pays?

Providers set their own chargemaster rates (billed charges), which are typically much higher than what any insurer pays. Medicare pays a fixed rate based on the procedure code and geographic location. The billed charge is relevant mainly for uninsured patients, who may face prices closer to the submitted charge.

How much does Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal) cost with insurance?

With commercial insurance, complete reconstruction of lower or upper jaw bone with jaw bone implant (subperiosteal) costs an estimated $848.50 on average (range: $593.95-$1,187.89), a moderate premium over Medicare's $302.49. Without insurance, the estimated cash price is $1,257.33.

How many providers perform Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal)?

Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal) is comparatively uncommon: only 14 providers nationally billed Medicare for it in 2023, serving 16 beneficiaries via 18 total services.

What is the billed-to-Medicare markup for Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal)?

Providers bill 11.7x what Medicare pays for Complete Reconstruction Of Lower Or Upper Jaw Bone With Jaw Bone Implant (subperiosteal) - one of the steepest markups in the catalog at 1070% above the Medicare rate.

Related Guides

Negotiating Your Medical Bill

Tips to reduce out-of-pocket costs
Hospital Price Transparency

Your right to upfront pricing
Understanding Medicare Costs

How Medicare payments work
How to Read a Medical Bill

Decode charges and codes
Hospital Markup Explained

Why bills exceed actual costs
Why Costs Vary by State

Geographic pricing factors

Data from CMS Medicare Physician & Other Practitioners (2023).

Read our methodology - how this data is sourced, computed, and verified.

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Data sourced from the CMS Medicare Physician and Other Practitioners dataset. See our methodology for details. Retrieved and formatted by PlainProcedure Editorial

Every figure on PlainProcedure is rendered directly from CMS Medicare Physician & Other Practitioners data, no number is typed in by an editor. This page draws directly on CMS Medicare Physician & Other Practitioners data, no figure is typed in by an editor. See our editorial standards & corrections policy, the methodology behind these numbers, or report a data error.