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Pennsylvania 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
$116.11 / $1,378.81 / $5,868.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.28 / $108.73 / $202.64
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.46 / $185.46 / $185.46
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,299.82 / $2,746.00 / $13,822.74
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.42 / $128.07 / $238.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.09 / $121.03 / $202.11
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.85 / $190.09 / $196.17
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$0.50 / $313.33 / $2,291.42
Highmark BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.41 / $121.03 / $210.17
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$146.50 / $1,633.00 / $7,175.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$73.98 / $114.26 / $440.23
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.84 / $106.80 / $180.24
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.88 / $138.88 / $138.88
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.69 / $124.56 / $228.87
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.04 / $80.53 / $123.84
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$80.04 / $99.01 / $132.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.00 / $674.00 / $4,300.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$103.62 / $140.91 / $249.82