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Washington rates for HCPCS 21255

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

Facilitymedian $3,467 · 10th–90th $1,738$19,9530%10%10th90th$3,467Professionalmedian $1,950 · 10th–90th $1,202$3,7150%10%20%10th90th$1,950$50.0$200.0$1.0K$5.0K$20.0K

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
$2,511.89 / $8,128.31 / $20,892.96
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,202.26 / $1,778.28 / $3,388.44
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$12,589.25 / $16,218.10 / $31,622.78
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,570.40 / $3,630.78
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$758.58 / $758.58 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,258.93 / $2,238.72 / $3,981.07
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,445.44 / $2,754.23 / $9,120.11
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,445.44 / $2,691.53 / $6,918.31
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $549.54
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,630.27 / $2,691.53
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $1,778.28 / $1,819.70
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,691.53 / $3,467.37
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$10,964.78 / $16,218.10 / $31,622.78
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,819.70 / $2,570.40 / $3,548.13
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$3,467.37 / $17,378.01 / $33,884.42
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,949.84 / $3,467.37
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,412.54 / $2,570.40