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Michigan rates for HCPCS 42225

Palatoplasty for cleft palate; attachment pharyngeal flap

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$4,897.79 / $4,897.79 / $5,754.40
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,047.13 / $1,819.70
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$251.19 / $295.12 / $295.12
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,479.11 / $1,548.82
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$891.25 / $1,288.25 / $2,570.40
Health Alliance Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $4,897.79 / $5,754.40
Health Alliance Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$912.01 / $1,071.52 / $1,445.44
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$776.25 / $1,096.48 / $2,137.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $7,079.46 / $12,882.50
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$870.96 / $1,148.15 / $1,659.59