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Washington, DC 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
$1,380.38 / $5,128.61 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,380.38 / $4,073.80
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $3,715.35 / $10,715.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,318.26 / $1,862.09 / $3,715.35
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,884.03 / $3,019.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $16,218.10 / $33,884.42
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,778.28 / $3,715.35