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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
$2,993.72 / $3,706.14 / $3,955.04
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,229.11 / $1,689.19 / $2,086.35
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,150.53 / $1,592.44 / $2,687.17
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,658.79 / $2,208.38 / $2,822.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,219.00 / $7,228.00 / $12,680.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,216.85 / $1,944.39 / $2,946.84