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Montana rates for HCPCS 28103

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

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $489.78 / $977.24
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $616.60 / $616.60
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $562.34 / $660.69
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $676.08 / $812.83
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $676.08 / $812.83
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$398.11 / $630.96 / $954.99
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $537.03 / $794.33
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $645.65 / $741.31