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Pennsylvania 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
$831.76 / $4,265.80 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $407.38 / $870.96
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$9,549.93 / $10,000.00 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$389.05 / $416.87 / $707.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$660.69 / $660.69 / $660.69
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $501.19 / $776.25
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $575.44 / $741.31
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $489.78 / $776.25
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$10,715.19 / $10,715.19 / $12,022.64
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $446.68 / $446.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $3,801.89 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$363.08 / $537.03 / $1,202.26
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $776.25 / $851.14
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $758.58 / $831.76
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$380.19 / $478.63 / $575.44
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$380.19 / $478.63 / $575.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $5,495.41 / $22,387.21
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $489.78 / $776.25