go back

Florida 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
$1,186.10 / $4,790.00 / $11,576.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.21 / $1,311.25 / $1,754.16
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$323.00 / $400.00 / $10,000.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.63 / $1,692.90 / $2,754.77
Florida Blue
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,139.00 / $12,804.00 / $23,031.00
Florida Blue
Facility/Professional
Professional
Modifier
Low / Median / High Price
$621.21 / $1,214.53 / $1,506.00
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.75 / $970.38 / $1,670.83
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,581.00 / $10,309.00 / $15,888.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.03 / $1,416.87 / $2,570.80
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.34 / $1,023.34 / $1,286.71