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Virginia rates for HCPCS 42104

Excision, lesion of palate, uvula; without closure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$160.43 / $3,309.00 / $8,294.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.26 / $208.97 / $303.77
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,060.00 / $3,693.00 / $4,290.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.36 / $207.99 / $326.64
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.40 / $146.84 / $295.14
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$150.34 / $226.85 / $610.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.40 / $224.84 / $398.18
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$206.24 / $257.80 / $380.86
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$155.69 / $242.48 / $377.04
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$252.00 / $301.00 / $407.00
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$138.74 / $174.31 / $313.86
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$198.06 / $265.87 / $512.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$500.00 / $2,774.00 / $5,710.07
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$166.19 / $239.44 / $416.16