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Louisiana 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
$841.00 / $2,167.00 / $4,217.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.36 / $1,321.75 / $1,737.80
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,588.66 / $8,416.15 / $12,057.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,277.61 / $1,504.11 / $1,866.08
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$40.00 / $946.28 / $2,807.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$725.00 / $1,150.00 / $4,042.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$944.60 / $1,411.08 / $2,143.21
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,100.00 / $4,717.00 / $10,959.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$915.23 / $1,308.52 / $2,228.03