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Colorado 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
$2,018.00 / $5,503.00 / $10,651.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,235.00 / $1,337.72 / $1,951.24
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,946.00 / $9,472.00 / $17,487.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,467.57 / $1,901.20 / $3,048.75
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,453.92 / $1,854.03 / $2,730.73
Denver HMP
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,337.72 / $1,768.98 / $2,407.90
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,456.92 / $1,920.48 / $2,648.94
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,251.00 / $11,924.00 / $19,712.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,468.80 / $1,936.53 / $3,078.74