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South Dakota rates for HCPCS 21255

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

Facilitymedian $2,089 · 10th–90th $1,349–$4,3650%20%10th90th$2,089Professionalmedian $1,778 · 10th–90th $1,230–$3,3110%10%10th90th$1,778$1.0K$2.0K$5.0K$10.0K

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
$1,348.96 / $1,348.96 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,122.02 / $1,348.96 / $2,754.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,754.23 / $3,162.28 / $3,890.45
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,621.81 / $2,238.72 / $3,388.44
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $2,511.89 / $10,964.78
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $3,235.94 / $3,235.94
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,818.38 / $2,818.38 / $3,090.30
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,584.89 / $2,187.76 / $2,570.40
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,466.84 / $4,466.84 / $12,022.64
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,318.26 / $2,344.23 / $3,890.45
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$2,570.40 / $3,162.28 / $3,162.28