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Pennsylvania rates for HCPCS 41870

Periodontal Mucosal Grafting

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$882.00 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.06 / $308.70 / $365.67
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$235.30 / $244.18 / $244.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$491.00 / $939.95 / $2,109.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$283.81 / $380.00 / $606.08
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,478.61 / $1,478.61 / $1,478.61
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.69 / $953.35 / $1,527.90
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,120.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$279.27 / $328.51 / $1,659.00
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $350.40 / $522.29
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.31 / $932.58 / $2,151.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$284.19 / $377.73 / $625.19
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$340.00 / $340.00 / $340.00
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$340.00 / $340.00 / $340.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$550.00 / $1,728.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$266.02 / $346.41 / $582.73