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New Mexico rates for HCPCS 21255

Reconstruction of zygomatic arch and glenoid fossa with bone and cartilage (includes obtaining autografts)

Facilitymedian $1,950 · 10th–90th $1,318–$7,7620%20%10th90th$1,950Professionalmedian $1,445 · 10th–90th $1,230–$2,3990%20%10th90th$1,445$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,905.46 / $1,949.84 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,380.38 / $2,344.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,174.90 / $1,905.46 / $4,570.88
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $33.11
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,778.28 / $2,884.03
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,230.27 / $1,949.84 / $2,754.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$891.25 / $11,748.98 / $25,703.96
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,949.84 / $2,754.23