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Minnesota 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
$1,348.96 / $1,348.96 / $6,760.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,230.27 / $1,380.38 / $2,137.96
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,762.47 / $13,803.84 / $31,622.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,089.30 / $3,162.28 / $4,786.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $4,897.79 / $11,748.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,398.83 / $3,981.07 / $5,888.44
Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,801.89 / $4,677.35 / $9,120.11
Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,511.89 / $3,311.31 / $5,370.32
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,412.54 / $2,630.27 / $9,772.37
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.25 / $2,630.27 / $7,762.47
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $5,754.40 / $12,589.25
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.96 / $2,454.71 / $4,786.30