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Illinois rates for HCPCS 28103

Excision or curettage of bone cyst or benign tumor, talus or calcaneus; with allograft

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$724.44 / $2,691.53 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $446.68 / $891.25
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $9,772.37 / $12,589.25
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $630.96 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,232.93 / $10,232.93 / $10,232.93
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $562.34 / $831.76
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $707.95 / $2,238.72
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $489.78 / $524.81
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $389.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,570.40 / $6,309.57 / $16,982.44
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $501.19 / $831.76