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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
$1,621.81 / $2,398.83 / $11,481.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $446.68 / $812.83
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,912.51 / $10,000.00 / $18,197.01
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $741.31 / $1,047.13
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,089.30 / $2,089.30 / $2,089.30
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $741.31 / $1,174.90
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $645.65 / $954.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$12,302.69 / $12,302.69 / $12,302.69
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $630.96 / $1,071.52
Well Sense
Facility/Professional
Facility
Modifier
Low / Median / High Price
$288.40 / $288.40 / $467.74