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Alaska rates for HCPCS 42210

Palatoplasty for cleft palate, with closure of alveolar ridge; with bone graft to alveolar ridge (includes obtaining graft)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,087.74 / $9,813.00 / $16,443.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,053.42 / $1,142.14 / $5,644.98
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,033.33 / $1,693.22 / $3,606.76
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065.40 / $5,644.98 / $7,902.97
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,632.20 / $3,894.63 / $7,180.36
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$2,789.60 / $4,890.60 / $8,031.71
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,065.40 / $5,644.98 / $7,902.97
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,288.19 / $3,870.00 / $7,073.56
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,440.83 / $2,885.40 / $7,958.91