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Michigan 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
$1,230.86 / $4,933.00 / $5,757.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.41 / $1,095.83 / $1,292.41
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,174.05 / $4,692.83 / $6,478.92
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$246.69 / $952.30 / $1,614.08
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$859.37 / $1,155.67 / $2,279.23
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$899.63 / $4,933.00 / $5,757.00
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$899.63 / $1,044.17 / $1,544.63
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$65.50 / $826.29 / $1,237.15
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,500.00 / $8,702.00 / $10,351.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$978.41 / $1,252.77 / $1,641.07