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Arizona 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
$1,965.00 / $4,521.00 / $7,960.15
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$986.30 / $1,091.58 / $2,052.10
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$888.80 / $3,318.56 / $5,814.97
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,105.26 / $1,263.15 / $1,468.41
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$717.00 / $3,280.17 / $5,374.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.60 / $1,241.78 / $2,329.87
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,021.27 / $1,257.53 / $6,506.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$947.59 / $1,229.52 / $11,430.60
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,350.00 / $6,230.00 / $9,010.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$922.24 / $1,151.04 / $2,097.92