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Pennsylvania rates for HCPCS 42500

Plastic repair of salivary duct, sialodochoplasty; primary or simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $4,073.80 / $8,317.64
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,456.54 / $7,585.78 / $57,543.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $870.96 / $8,128.31
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $707.95 / $707.95
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,818.38 / $11,748.98 / $26,302.68
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $3,801.89 / $8,317.64
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.87 / $467.74 / $954.99
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $380.19 / $467.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$851.14 / $2,951.21 / $16,982.44