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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

Facilitymedian $5,129 · 10th–90th $1,000–$8,9130%10%10th90th$5,129Professionalmedian $794 · 10th–90th $427–$2,5700%5%10%10th90th$794$50.0$200.0$1.0K$5.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,000.00 / $5,128.61 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$426.58 / $812.83 / $2,570.40
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$478.63 / $691.83 / $1,000.00
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $851.14
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$4,677.35 / $6,309.57 / $9,772.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $851.14 / $1,348.96
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$501.19 / $912.01 / $1,230.27
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$575.44 / $812.83 / $1,071.52
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $5,128.61 / $7,079.46
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $575.44 / $933.25