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Texas rates for HCPCS 42500

Plastic repair of salivary duct, sialodochoplasty; primary or simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$542.70 / $3,060.00 / $10,234.00
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,471.03 / $7,081.77 / $14,309.06
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$305.23 / $305.23 / $434.56
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,024.00 / $3,741.00 / $4,187.68
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,394.60 / $11,500.00 / $26,542.00
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$346.74 / $472.46 / $804.46
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$347.09 / $478.64 / $952.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,190.00 / $3,239.00 / $7,600.00