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Pennsylvania rates for HCPCS 21210

Graft, bone; nasal, maxillary or malar areas (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,513.56 / $7,244.36 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,621.81 / $3,235.94
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,071.52 / $1,148.15
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $1,288.25 / $1,288.25
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,621.81 / $3,311.31
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,137.96 / $2,951.21 / $3,715.35
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $2,041.74 / $2,951.21
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,589.25 / $14,454.40 / $22,387.21
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $5,623.41 / $11,220.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,862.09 / $4,786.30
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,047.13 / $1,047.13 / $3,801.89
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $4,897.79
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$741.31 / $1,258.93 / $1,949.84
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $933.25 / $1,819.70
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.23 / $4,466.84 / $18,197.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $1,513.56 / $3,090.30