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Utah rates for HCPCS 28102

Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with iliac or other autograft (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,162.28 / $4,570.88 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $776.25 / $3,388.44
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$562.34 / $812.83 / $1,412.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,071.52
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,471.29 / $12,302.69 / $28,183.83
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,174.90 / $1,862.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,122.02 / $1,258.93
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,000.00 / $1,513.56
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,019.95 / $5,128.61 / $15,848.93
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $616.60 / $954.99