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Rhode Island 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
$3,019.95 / $3,715.35 / $3,981.07
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,380.38 / $3,630.78
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,348.96 / $2,398.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,513.56 / $1,949.84 / $2,884.03
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,235.94 / $7,413.10 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,698.24 / $3,019.95