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New Hampshire 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
$100.00 / $1,640.10 / $9,859.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$364.14 / $388.31 / $500.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,512.20 / $9,458.00 / $17,400.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$381.04 / $653.41 / $973.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$443.04 / $2,000.36 / $2,070.38
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.77 / $760.64 / $1,135.48
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.21 / $715.65 / $1,346.36
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,399.00 / $12,399.00 / $12,399.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.62 / $621.16 / $1,078.54
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$307.10 / $337.81 / $429.94