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Montana 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
$979.17 / $1,091.58 / $5,783.87
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $77,999.99 / $94,999.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.86 / $1,698.86 / $1,698.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,028.56 / $1,515.70 / $2,724.90
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,050.91 / $1,517.79 / $1,956.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,091.63 / $1,723.28 / $2,871.61
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,489.89 / $1,821.43 / $2,288.08