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Utah rates for HCPCS 42215

Palatoplasty Cleft Palate Major Revj

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$960.86 / $4,312.00 / $9,932.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$651.42 / $960.86 / $2,031.41
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$693.29 / $962.26 / $1,459.74
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$56.28 / $515.83 / $696.92
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,413.68 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$920.34 / $1,136.08 / $1,441.69
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$633.63 / $847.06 / $1,428.68