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Throat Flap Surgery for Cleft Palate Speech

Pennsylvania rates for HCPCS 42225

Surgery that lifts a flap of tissue from the back wall of the throat and attaches it to the soft palate, narrowing the gap between the mouth and the nose. It is done when too much air escapes through the nose during speech, leaving it sounding very nasal after a cleft palate has been repaired. Closing that gap lets the palate seal so speech sounds clearer.

Facilitymedian $6,026 · 10th–90th $1,148$10,0000%10%10th90th$6,026Professionalmedian $1,072 · 10th–90th $871$1,9500%20%10th90th$1,072$10.0$50.0$200.0$1.0K$5.0K$20.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,380.38
Median
$6,025.60
Typical High
$9,549.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,047.13
Typical High
$1,862.09
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$9,549.93
Median
$10,000.00
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,479.11
Typical High
$1,479.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$2,754.23
Typical High
$8,128.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,122.02
Typical High
$1,949.84
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,412.54
Typical High
$1,995.26
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$4,265.80
Typical High
$5,248.07
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,096.48
Typical High
$1,698.24
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$10,715.19
Median
$10,715.19
Typical High
$26,302.68
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$4,786.30
Typical High
$8,709.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,047.13
Typical High
$2,290.87
Oscar Health
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,737.80
Typical High
$2,089.30
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$691.83
Typical High
$954.99
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$912.01
Typical High
$977.24
United
Setting
Facility
Modifier
Global
Typical Low
$1,659.59
Median
$4,897.79
Typical High
$19,054.61
United
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$1,071.52
Typical High
$1,819.70