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Utah rates for HCPCS 13121

Repair, complex, scalp, arms, and/or legs; 2.6 cm to 7.5 cm

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$457.09 / $4,570.88 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $371.54 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $426.58 / $660.69
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $812.83
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,023.29 / $2,454.71
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.84 / $524.81 / $776.25
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$295.12 / $436.52 / $724.44
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$316.23 / $537.03 / $794.33
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$234.42 / $363.08 / $562.34