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Arkansas 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
$1,233.00 / $1,821.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.36 / $1,230.60 / $1,499.39
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$5,430.62 / $5,430.62 / $6,190.91
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,133.24 / $1,499.88 / $1,666.53
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$515.00 / $789.00 / $4,337.37
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$905.93 / $1,495.00 / $1,938.97
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,565.00 / $2,595.00 / $6,957.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$953.88 / $1,288.21 / $2,187.35