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Michigan rates for HCPCS 42104

Excision, lesion of palate, uvula; without closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$170.36 / $2,877.00 / $7,133.32
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.68 / $194.00 / $271.50
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.18 / $301.41 / $416.13
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$36.45 / $191.66 / $234.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.46 / $215.39 / $444.67
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$173.42 / $2,877.00 / $4,933.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.40 / $216.89 / $334.18
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.13 / $205.46 / $296.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,527.00 / $4,941.00 / $7,383.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.82 / $272.95 / $358.02