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Pennsylvania rates for HCPCS 42505

Plastic repair of salivary duct, sialodochoplasty; secondary or complicated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$614.36 / $4,122.00 / $8,404.00
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,639.91 / $11,851.00 / $26,582.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$649.00 / $2,656.00 / $8,051.32
Emblem Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,028.27 / $1,028.27 / $1,028.27
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,272.00 / $12,495.40 / $16,066.13
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,020.00 / $4,761.00 / $8,404.00
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$553.50 / $553.50 / $553.50
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$649.00 / $2,109.00 / $7,661.29
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$450.48 / $483.08 / $579.66
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,530.00 / $3,879.00 / $7,000.00