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New Mexico 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
$1,000.00 / $2,095.00 / $7,838.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,207.99 / $1,379.67 / $4,972.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.84 / $1,954.77 / $2,579.52
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $2,034.65
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,208.04 / $1,680.00 / $3,002.20
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,348.12 / $2,089.58 / $3,285.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.00 / $11,259.00 / $16,897.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,507.17 / $2,019.58 / $3,141.03