go back

Illinois rates for HCPCS 13122

Repair Complex Scalp/Arm/Leg Ea Addl 5 Cm/<

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.38 / $1,055.00 / $4,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.81 / $108.73 / $217.06
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$176.53 / $176.53 / $176.53
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$430.81 / $921.52 / $1,845.34
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$97.55 / $142.51 / $212.26
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$875.00 / $875.00 / $908.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$89.89 / $133.24 / $218.38
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.61 / $177.75 / $446.41
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$95.67 / $103.43 / $169.99
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $196.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.00 / $1,032.00 / $3,686.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.72 / $159.03 / $286.95