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Washington 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
$327.48 / $2,769.52 / $18,711.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $1,300.00 / $2,000.00
Asuris Northwest Health
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$25.04 / $83.11 / $83.11
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$714.97 / $765.00 / $870.49
Kaiser Permanente
Facility/Professional
Facility
Modifier
Low / Median / High Price
$184.86 / $349.94 / $452.76
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$262.60 / $343.91 / $367.83
Premera BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.98 / $245.98 / $250.89
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,155.00 / $3,129.00 / $11,941.00