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Indiana 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
$1,050.93 / $1,854.00 / $16,042.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.36 / $1,056.29 / $1,481.31
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,641.00 / $10,700.00 / $17,513.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.42 / $1,251.30 / $1,709.20
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$969.66 / $1,260.56 / $1,454.49
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.66 / $1,112.68 / $1,454.49
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$865.00 / $1,210.81 / $3,909.74
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$983.24 / $1,357.93 / $2,218.32
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,529.00 / $9,550.00 / $15,750.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$969.94 / $1,195.44 / $2,255.50