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Pennsylvania 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
$1,022.22 / $4,761.00 / $8,451.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.61 / $954.44 / $1,230.86
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$960.21 / $996.45 / $996.45
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$739.00 / $1,993.85 / $3,928.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$799.67 / $1,187.59 / $1,910.96
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,161.01 / $2,161.01 / $2,161.01
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,148.42 / $1,516.34 / $1,952.20
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.00 / $5,350.00 / $9,617.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$868.61 / $1,030.58 / $5,041.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$842.20 / $842.20 / $842.20
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $1,132.80 / $2,465.69
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$739.00 / $1,978.20 / $3,738.29
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$800.05 / $1,170.16 / $1,945.38
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.80 / $942.17 / $942.17
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$851.80 / $942.17 / $997.61
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,530.00 / $3,879.00 / $7,000.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$844.99 / $1,123.27 / $1,883.17