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Arizona 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
$1,737.80 / $3,890.45 / $7,413.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $645.65 / $2,290.87
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$323.59 / $407.38 / $549.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$630.96 / $2,041.74 / $3,019.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $724.44 / $1,412.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $660.69 / $1,096.48
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$446.68 / $660.69 / $3,630.78
Medica
Facility/Professional
Facility
Modifier
AS
Low / Median / High Price
$204.17 / $204.17 / $204.17
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $794.33 / $4,466.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,290.87 / $3,311.31 / $5,370.32
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $575.44 / $954.99