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Louisiana rates for HCPCS 13122

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$156.41 / $1,172.00 / $3,500.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.73 / $108.73 / $179.92
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$242.63 / $338.00 / $459.28
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.71 / $131.91 / $171.07
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$83.70 / $83.70 / $83.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$85.55 / $130.71 / $207.44
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$194.00 / $513.00 / $1,226.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.93 / $130.07 / $205.42