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Alaska rates for HCPCS 28122

Partial excision (craterization, saucerization, sequestrectomy, or diaphysectomy) bone (eg, osteomyelitis or bossing); tarsal or metatarsal bone, except talus or calcaneus

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,890.45 / $10,715.19 / $20,417.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $691.83 / $1,348.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,096.48 / $1,479.11 / $2,570.40
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$501.19 / $1,202.26 / $7,413.10
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,584.89 / $2,884.03
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,548.82 / $2,398.83 / $3,311.31
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$512.86 / $870.96 / $3,019.95
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$60.26 / $812.83 / $1,479.11
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$676.08 / $2,089.30 / $3,162.28