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Oklahoma 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
$1,404.30 / $4,195.00 / $13,200.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,109.78 / $1,404.30 / $1,404.30
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$900.00 / $900.00 / $900.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,398.31 / $1,797.07 / $2,189.12
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,328.49 / $1,938.75 / $8,753.15
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,205.27 / $1,554.99 / $10,981.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,481.00 / $5,910.00 / $9,232.95
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,134.36 / $1,417.96 / $1,999.32