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Utah 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
$1,000.00 / $5,128.61 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $707.95 / $2,511.89
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $691.83 / $1,230.27
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $851.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,677.35 / $5,495.41 / $12,589.25
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $891.25 / $1,348.96
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$501.19 / $851.14 / $1,230.27
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$602.56 / $812.83 / $1,174.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,995.26 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$407.38 / $575.44 / $870.96