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Pennsylvania rates for HCPCS 20902

Bone Graft Any Donor Area Major/Large

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$564.33 / $3,612.00 / $8,240.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.69 / $311.69 / $311.69
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$30.65 / $30.65 / $30.65
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,492.24 / $18,968.65 / $59,350.57
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$926.00 / $4,534.00 / $8,404.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$311.69 / $311.69 / $311.69
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$30.65 / $30.65 / $30.65
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$268.89 / $268.89 / $617.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,368.00