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Pennsylvania rates for HCPCS 21215

Graft Bone Mandible

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,426.00 / $4,469.01 / $10,600.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$757.72 / $3,374.21 / $4,484.20
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,837.97 / $3,982.80 / $3,982.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,349.47 / $1,349.47 / $1,349.47
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$806.09 / $2,947.14 / $6,512.32
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,694.80 / $6,260.19 / $8,109.20
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,850.90 / $12,495.40 / $16,066.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,459.00 / $5,511.00 / $11,182.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$766.14 / $3,374.21 / $7,188.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$952.40 / $952.40 / $9,227.40
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,349.47 / $1,349.47 / $1,349.47
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$807.27 / $2,989.84 / $6,721.13
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$766.53 / $1,877.80 / $3,925.36
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$765.64 / $2,881.40 / $4,284.62
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,332.00 / $3,879.00 / $7,508.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,095.79 / $4,589.56 / $7,996.57