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North Carolina rates for HCPCS 28104

Excision or curettage of bone cyst or benign tumor, tarsal or metatarsal, except talus or calcaneus;

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$466.03 / $1,722.57 / $7,364.02
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$530.04 / $530.04 / $2,710.28
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$344.19 / $599.28 / $898.00
Medcost
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$81.90 / $108.90 / $135.02
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,661.00 / $7,659.00 / $10,502.00
Wellcare
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,657.60 / $1,827.99 / $16,394.00
Wellcare
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$93.62 / $182.80 / $182.80