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Michigan 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
$4,073.80 / $4,073.80 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $389.05 / $691.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $870.96 / $870.96
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $645.65 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $501.19 / $851.14
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $4,073.80 / $5,754.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $446.68 / $616.60
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $478.63 / $724.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,495.41 / $9,120.11 / $16,595.87
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $489.78 / $660.69