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Hawaii 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
$1,778.28 / $2,818.38 / $4,466.84
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $602.56 / $870.96
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $630.96 / $851.14
HMSA
Facility/Professional
Professional
Modifier
Low / Median / High Price
$724.44 / $891.25 / $3,981.07
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $707.95 / $831.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$371.54 / $630.96 / $954.99
University Health Alliance
Facility/Professional
Professional
Modifier
Low / Median / High Price
$537.03 / $2,570.40 / $6,165.95