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Utah rates for HCPCS 13122

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$91.81 / $2,910.00 / $4,387.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$71.51 / $113.78 / $248.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$96.30 / $139.38 / $198.54
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.11 / $90.31 / $112.17
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$90.41 / $139.41 / $205.99
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,078.00 / $1,556.00 / $4,495.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.52 / $130.90 / $189.00