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Maine 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
Professional
Modifier
Low / Median / High Price
$977.24 / $1,148.15 / $2,398.83
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,584.89 / $2,570.40
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$977.24 / $977.24 / $1,819.70
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$812.83 / $1,412.54 / $2,511.89
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,174.90 / $1,819.70 / $3,019.95
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,548.82 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,445.44 / $2,454.71