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Pennsylvania rates for HCPCS 20938

Autograft for spine surgery only (includes harvesting the graft); structural, bicortical or tricortical (through separate skin or fascial incision) (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$641.00 / $2,505.00 / $7,197.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$13,531.00 / $27,840.00 / $46,296.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.57 / $208.57 / $208.57
Cigna
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$20.47 / $20.47 / $20.47
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$657.00 / $2,422.00 / $8,017.00
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$208.57 / $208.57 / $208.57
Priority Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$20.47 / $20.47 / $20.47
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$178.01 / $178.01 / $205.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,475.00 / $6,368.00