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Idaho 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
$3,422.00 / $4,500.00 / $8,622.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,386.55 / $1,947.67 / $2,778.15
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,529.44 / $2,039.25 / $2,464.98
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,280.49 / $2,426.06 / $3,333.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,139.14 / $2,333.61 / $3,169.01
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $1,867.41 / $2,349.32
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,662.17 / $14,534.58 / $18,446.52
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,229.09 / $2,656.00 / $3,169.01
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,100.00 / $10,120.00 / $27,159.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,493.01 / $2,121.67 / $3,098.52