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Maine rates for HCPCS 13122

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $67.20 / $2,221.28
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $104.91 / $202.64
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.81 / $138.77 / $191.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$106.35 / $166.74 / $260.29
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.99 / $156.94 / $261.63
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.41 / $278.89 / $2,221.28
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.20 / $104.91 / $198.79
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.80 / $182.85 / $275.82