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Alaska rates for HCPCS 42104

Excision, lesion of palate, uvula; without closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$598.66 / $7,340.00 / $13,413.92
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.88 / $219.67 / $1,094.49
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$163.35 / $305.38 / $674.57
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$132.19 / $704.66 / $1,532.29
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$350.00 / $678.45 / $1,365.00
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$445.50 / $796.00 / $1,254.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.79 / $704.66 / $1,532.29
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$245.20 / $608.19 / $1,201.20
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$277.77 / $563.63 / $1,488.57