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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
$540.00 / $3,745.00 / $7,799.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.00 / $2,019.00 / $8,051.32
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$778.34 / $778.34 / $778.34
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,810.00 / $12,495.40 / $26,260.57
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.00 / $3,839.00 / $8,017.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$416.80 / $416.80 / $416.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$526.00 / $1,657.00 / $7,661.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.94 / $345.08 / $439.48
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$825.00 / $2,715.00 / $4,815.00