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Missouri 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
$2,089.30 / $5,128.61 / $9,772.37
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,230.27 / $3,715.35
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,238.72 / $5,011.87 / $10,000.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,071.52 / $1,288.25 / $2,089.30
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,000.00 / $1,202.26 / $1,737.80
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,548.13 / $3,548.13 / $3,548.13
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $1,348.96 / $2,137.96
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,023.29 / $1,659.59 / $11,220.18
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,047.13 / $1,621.81 / $11,481.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,454.71 / $3,981.07 / $7,943.28
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$977.24 / $1,348.96 / $2,187.76