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Pennsylvania rates for HCPCS 21215

Graft, bone; mandible (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $7,244.36 / $11,220.18
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $3,388.44 / $6,025.60
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
$1,122.02 / $1,122.02 / $1,202.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,348.96 / $1,348.96 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $2,691.53 / $6,760.83
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$4,897.79 / $6,918.31 / $8,511.38
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $4,168.69 / $6,606.93
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,748.98 / $12,589.25 / $15,848.93
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,288.25 / $5,754.40 / $11,220.18
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $3,467.37 / $9,120.11
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,096.48 / $9,120.11
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$954.99 / $1,412.54 / $9,120.11
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $933.25 / $3,890.45
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$741.31 / $933.25 / $3,890.45
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
$741.31 / $1,737.80 / $6,025.60