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Texas 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
$706.00 / $3,213.00 / $11,747.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$355.37 / $391.60 / $625.15
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,075.37 / $9,092.56 / $18,364.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$351.86 / $435.65 / $611.07
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$673.20 / $8,100.00 / $14,437.12
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$408.95 / $439.75 / $776.98
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$355.27 / $8,464.19 / $8,464.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$443.04 / $443.04 / $443.04
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$391.84 / $537.33 / $860.51
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,439.16 / $26,542.00 / $29,777.20
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,959.35 / $3,959.35 / $3,959.35
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.47 / $547.95 / $857.99
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$476.30 / $571.55 / $708.73
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$360.57 / $475.48 / $674.26
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$381.47 / $559.33 / $879.80
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$398.30 / $552.76 / $837.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,605.00 / $7,184.00 / $16,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$320.22 / $425.93 / $689.61
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$325.20 / $371.77 / $516.23