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Arkansas 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
$1,277.00 / $1,718.43 / $9,034.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,212.09 / $1,707.47 / $1,947.67
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,419.79 / $1,774.74 / $1,879.14
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,521.33 / $2,098.41 / $2,482.92
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,565.00 / $2,828.00 / $6,992.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,233.63 / $1,526.49 / $2,533.66