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Vermont rates for HCPCS 21255

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,589.18 / $1,705.23 / $1,705.23
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,405.67 / $2,397.51 / $3,116.12
MVP Health Care
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,433.10 / $2,051.19 / $3,116.12
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,664.91 / $1,957.19 / $5,689.68