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Maine rates for HCPCS 42104

Excision, lesion of palate, uvula; without closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,528.68 / $1,528.68 / $1,528.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.22 / $209.80 / $340.97
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$164.87 / $259.42 / $354.47
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.85 / $226.85 / $611.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$168.11 / $274.29 / $481.65
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$169.00 / $267.93 / $475.55
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,528.68 / $1,528.68 / $1,528.68
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.41 / $224.31 / $358.72
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$207.13 / $303.72 / $462.42