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Massachusetts 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
$1,513.56 / $3,630.78 / $6,918.31
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,230.27 / $3,715.35
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $4,897.79 / $16,595.87
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,698.24 / $11,481.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,949.84 / $2,187.76 / $3,311.31
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$954.99 / $1,047.13 / $6,456.54
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$512.86 / $1,445.44 / $2,884.03
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$812.83 / $1,995.26 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,445.44 / $2,137.96
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $5,011.87 / $13,182.57
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,023.29 / $1,819.70 / $2,818.38
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,905.46 / $4,897.79 / $16,595.87
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,659.59 / $11,481.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,584.89 / $5,370.32 / $13,182.57
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,584.89 / $3,019.95