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Maine 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
$4,073.80 / $4,073.80 / $4,073.80
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,047.13 / $2,089.30
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,348.96 / $2,187.76
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$707.95 / $1,202.26 / $2,187.76
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,548.82 / $2,630.27
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,073.80 / $4,073.80 / $4,073.80
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.14 / $1,348.96 / $2,630.27
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,258.93 / $2,137.96