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Pennsylvania rates for HCPCS 42104

Excision, lesion of palate, uvula; without closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$161.52 / $2,605.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.68 / $201.05 / $335.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,736.00 / $4,444.00 / $15,949.31
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$185.95 / $218.77 / $218.77
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$226.85 / $422.34 / $1,403.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$139.22 / $215.39 / $377.42
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.58 / $303.58 / $303.58
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$255.28 / $338.47 / $432.47
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,142.44 / $2,796.40 / $17,020.00
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$214.06 / $2,679.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.19 / $222.64 / $658.42
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$179.90 / $179.90 / $179.90
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $214.10 / $582.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$221.18 / $429.00 / $1,865.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$140.31 / $219.65 / $391.32
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.37 / $153.69 / $211.04
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$131.02 / $161.88 / $227.35
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$573.00 / $2,533.00 / $10,329.04
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$174.30 / $245.73 / $411.43