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Maryland rates for HCPCS 42815

Excision branchial cleft cyst, vestige, or fistula, extending beneath subcutaneous tissues and/or into pharynx

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,370.32 / $5,888.44 / $7,943.28
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $2,754.23 / $3,890.45
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $562.34 / $851.14
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,230.27 / $1,862.09 / $3,630.78