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Hawaii rates for HCPCS 21255

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

Facilitymedian $5,495 · 10th–90th $1,950–$5,4950%50%10th$5,495Professionalmedian $1,585 · 10th–90th $1,230–$2,3440%10%10th90th$1,585$50.0$100.0$200.0$500.0$1.0K$2.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,949.84 / $5,495.41 / $5,495.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,445.44 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,698.24 / $2,041.74
HMSA
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,862.09 / $2,137.96 / $2,344.23
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,513.56 / $1,905.46
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,884.03 / $2,884.03 / $2,884.03
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,380.38 / $1,659.59 / $2,089.30
University Health Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$29.51 / $1,258.93 / $2,290.87