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Missouri 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
$1,547.00 / $5,389.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.21 / $1,347.14 / $2,142.60
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,088.00 / $4,247.00 / $9,663.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,272.20 / $1,648.04 / $2,610.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,293.13 / $1,831.16 / $3,036.76
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,172.77 / $1,951.63 / $4,813.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,330.79 / $1,922.45 / $10,981.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,858.00 / $4,000.00 / $11,258.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,276.16 / $1,772.45 / $2,871.07