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Utah 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
$123.03 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$70.79 / $114.82 / $288.40
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $131.83 / $199.53
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $263.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$91.20 / $141.25 / $218.78
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$93.33 / $138.04 / $218.78
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$100.00 / $158.49 / $223.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$74.13 / $109.65 / $173.78