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Indiana rates for HCPCS 13122

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$68.29 / $197.20 / $5,634.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$68.29 / $101.76 / $148.19
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.10 / $113.10 / $113.10
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$90.84 / $90.84 / $175.32
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.73 / $99.60 / $147.03
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.80 / $95.85 / $155.59
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$113.10 / $135.72 / $163.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$84.40 / $117.14 / $176.53
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$933.00 / $2,252.00 / $4,426.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.33 / $134.97 / $204.86