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Maine 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
$588.84 / $6,309.57 / $8,912.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $602.56 / $1,258.93
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$416.87 / $645.65 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$549.54 / $794.33 / $1,230.27
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $741.31 / $1,479.11
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$588.84 / $3,467.37 / $8,912.51
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $691.83 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.09 / $676.08 / $1,174.90