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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
$1,091.58 / $1,324.18 / $1,324.18
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,240.94 / $1,459.93 / $2,221.96
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$982.00 / $982.00 / $1,210.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.72 / $1,420.02 / $2,329.87
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,205.33 / $1,552.36 / $2,429.17
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,073.05 / $1,271.27 / $1,344.86
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,057.00 / $1,449.99 / $2,381.40