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Indiana 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 / $4,897.79 / $14,125.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,348.96 / $2,398.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $19,952.62 / $27,542.29
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,548.82 / $2,454.71
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,202.26 / $1,348.96 / $1,513.56
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,698.24 / $2,691.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,466.84 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,479.11 / $2,570.40