go back

Louisiana 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
$933.25 / $2,691.53 / $5,888.44
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,412.54 / $1,698.24 / $2,137.96
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $398.11 / $398.11
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,778.28 / $2,511.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,148.15 / $5,370.32 / $11,748.98
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,122.02 / $1,479.11 / $2,398.83