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Utah 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
$3,162.28 / $6,025.60 / $9,332.54
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,000.00 / $2,691.53
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$575.44 / $1,148.15 / $1,949.84
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,819.70
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,317.64 / $10,000.00 / $22,387.21
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,202.26 / $1,445.44 / $1,862.09
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,698.24 / $2,344.23
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,348.96 / $1,995.26
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,884.03 / $5,128.61 / $13,803.84
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$794.33 / $1,000.00 / $1,621.81