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Alabama rates for HCPCS 21255

Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,513.56 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $2,570.40
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,165.95 / $7,244.36 / $9,772.37
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,778.28 / $2,290.87
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $2,238.72 / $2,238.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,548.82 / $3,162.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $4,265.80 / $6,918.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,380.38 / $2,344.23