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Montana 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
$3,311.31 / $8,912.51 / $8,912.51
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$446.68 / $741.31 / $4,073.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$46,773.51 / $81,283.05 / $95,499.26
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $776.25 / $933.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $676.08 / $933.25
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$758.58 / $1,000.00 / $1,071.52
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,000.00 / $1,071.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$489.78 / $724.44 / $1,174.90
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $741.31 / $1,174.90
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $831.76 / $1,096.48