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New Hampshire 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
$100.00 / $3,385.96 / $3,764.10
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$882.63 / $1,008.01 / $1,230.86
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,449.90 / $1,611.00 / $2,875.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$942.58 / $1,683.15 / $2,704.98
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,862.32 / $2,862.32 / $2,962.50
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.87 / $1,701.84 / $2,666.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,079.05 / $1,866.54 / $3,330.49
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$972.00 / $4,574.00 / $11,155.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,001.39 / $1,512.38 / $2,860.74
Well Sense
Facility/Professional
Professional
Modifier
Low / Median / High Price
$779.35 / $857.29 / $1,091.08