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Indiana rates for HCPCS 42200

Palatoplasty for cleft palate, soft and/or hard palate only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,071.52 / $4,265.80 / $22,908.68
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $977.24 / $1,819.70
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.96 / $630.96 / $630.96
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,570.88 / $18,197.01 / $26,302.68
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$758.58 / $1,000.00 / $1,548.82
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $933.25 / $1,047.13
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $794.33 / $794.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$870.96 / $1,548.82 / $3,890.45
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $1,202.26 / $1,778.28
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,265.80 / $9,549.93 / $16,218.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $977.24 / $1,548.82