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Pennsylvania rates for HCPCS 42220

Palatoplasty for cleft palate; secondary lengthening procedure

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.00 / $4,761.00 / $8,933.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$498.09 / $570.76 / $734.55
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
$575.64 / $597.37 / $597.37
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$690.00 / $3,025.00 / $8,073.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$505.52 / $688.49 / $1,137.71
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,303.70 / $1,303.70 / $1,303.70
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$692.09 / $919.91 / $1,174.88
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,881.83 / $11,881.83 / $11,881.83
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,151.00 / $5,350.00 / $10,247.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$510.61 / $682.18 / $3,121.96
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$583.70 / $583.70 / $583.70
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $761.30 / $1,495.10
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$652.83 / $2,760.00 / $7,820.94
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.74 / $688.49 / $1,169.64
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$507.97 / $564.26 / $564.26
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$507.97 / $564.26 / $600.41
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
$501.13 / $677.41 / $1,126.95