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California rates for HCPCS 21215

Graft Bone Mandible

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,843.00 / $9,490.00 / $23,163.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$762.19 / $3,374.21 / $5,329.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,671.50 / $1,671.50 / $1,671.50
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,585.00 / $11,216.00 / $21,514.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,007.07 / $1,319.94 / $4,206.91
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.00 / $100.00 / $15,290.89
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.51 / $2,352.53 / $4,933.85
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,445.00 / $7,572.03 / $13,561.85
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.66 / $2,673.44 / $8,453.76
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$744.60 / $1,125.11 / $6,396.24
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.77 / $2,919.00 / $7,877.56
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,299.89 / $7,299.89 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$14,822.85 / $28,693.84 / $33,725.62
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$813.57 / $1,449.22 / $6,466.86
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$896.70 / $2,781.13 / $9,566.81
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,672.91 / $2,672.91 / $13,981.55
The Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$833.28 / $1,220.70 / $5,927.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,142.00 / $12,341.00 / $26,451.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,966.34 / $3,891.23 / $10,745.92