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Texas 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
$114.63 / $1,937.00 / $6,000.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.97 / $103.63 / $172.02
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.28 / $114.28 / $182.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$95.99 / $202.80 / $7,770.00
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$75.80 / $117.58 / $172.38
Baylor Scott & White
Facility/Professional
Facility
Modifier
Low / Median / High Price
$80.31 / $145.97 / $807.97
Baylor Scott & White
Facility/Professional
Professional
Modifier
Low / Median / High Price
$87.02 / $132.55 / $189.26
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$66.73 / $83.70 / $124.10
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$88.49 / $133.37 / $204.80
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$399.57 / $12,000.00 / $12,000.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$589.84 / $904.80 / $1,056.08
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.58 / $117.75 / $177.09
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.96 / $152.44 / $219.51
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$67.91 / $114.93 / $146.52
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$77.50 / $117.75 / $178.24
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$92.85 / $141.38 / $226.05
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.00 / $952.00 / $2,405.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$101.55 / $134.97 / $191.15
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.08 / $104.08 / $164.82