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Virginia 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
$1,031.07 / $5,412.00 / $9,011.65
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,153.00 / $7,363.00 / $9,410.00
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$608.17 / $1,142.00 / $3,282.37
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$514.45 / $643.05 / $943.41
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$566.44 / $730.20 / $1,089.58
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$557.28 / $698.92 / $1,265.74
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,745.00 / $10,466.00 / $21,401.00