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North Dakota 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
$1,386.55 / $1,386.55 / $8,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,300.19 / $1,363.67 / $1,411.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,635.36 / $2,899.02 / $3,399.26
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,657.92 / $3,312.31 / $4,412.00
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,386.55 / $1,620.56 / $2,357.14
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,417.96 / $2,496.31 / $3,615.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,417.96 / $2,496.31 / $3,370.81