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Pennsylvania rates for HCPCS 20902

Bone graft, any donor area; major or large

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $5,011.87 / $8,511.38
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $7,585.78 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $467.74 / $467.74
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$46.77 / $46.77 / $46.77
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $19,054.61 / $58,884.37
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $4,570.88 / $8,511.38
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$562.34 / $562.34 / $741.31
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$269.15 / $575.44 / $616.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $3,981.07 / $22,387.21