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Washington, DC 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
$1,614.00 / $4,100.00 / $6,996.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,050.93 / $1,272.78 / $2,632.49
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,151.65 / $1,175.68 / $4,186.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,003.58 / $1,325.69 / $2,813.96
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,127.90 / $1,187.26 / $2,464.16
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,261.00 / $4,165.00 / $26,408.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$904.19 / $1,181.48 / $2,995.49