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Indiana rates for HCPCS 42205

Palatoplasty for cleft palate, with closure of alveolar ridge; soft tissue only

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$941.56 / $1,854.00 / $16,042.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$880.41 / $972.25 / $1,327.15
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.35 / $651.35 / $651.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,904.00 / $7,747.00 / $14,389.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$735.76 / $919.70 / $1,269.18
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$868.46 / $1,129.00 / $1,302.69
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.46 / $1,042.15 / $1,302.69
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$865.00 / $1,084.92 / $1,868.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$881.10 / $1,150.71 / $1,939.50
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,529.00 / $9,550.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$838.04 / $1,050.95 / $2,025.09