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Texas rates for HCPCS 20902

Bone Graft Any Donor Area Major/Large

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$803.00 / $3,511.00 / $12,114.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,606.10 / $8,972.92 / $18,364.59
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$625.00 / $6,249.30 / $9,390.95
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$237.01 / $2,476.62 / $2,476.62
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
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,772.19 / $19,913.50 / $26,542.00
Lucent Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$78.72 / $1,887.52 / $1,887.52
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.06 / $442.63 / $848.54
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$265.22 / $445.19 / $852.86
Providence
Facility/Professional
Facility
Modifier
80
Low / Median / High Price
$104.97 / $104.97 / $104.97
Providence
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$30.65 / $30.65 / $89.22
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,634.00 / $4,345.00 / $10,600.00