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Nebraska rates for HCPCS 13122

Repair, complex, scalp, arms, and/or legs; each additional 5 cm or less (List separately in addition to code for primary procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.96 / $2,187.76 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.86 / $173.78 / $794.33
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$72.44 / $93.33 / $177.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,162.28 / $6,165.95
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $151.36 / $239.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $245.47 / $363.08
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$81.28 / $181.97 / $616.60
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $263.03 / $933.25
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $251.19 / $380.19
Midlands
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $251.19 / $275.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,548.82 / $4,570.88
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $181.97 / $295.12