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Ohio 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
$1,570.70 / $6,064.00 / $11,581.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.36 / $1,079.21 / $1,952.69
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,755.00 / $3,555.00 / $19,117.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$890.46 / $1,157.58 / $1,931.87
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,013.33 / $1,216.00 / $1,505.06
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,022.71 / $1,114.66 / $1,317.33
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.00 / $4,048.28 / $5,935.99
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$939.82 / $1,404.18 / $2,139.59
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Low / Median / High Price
$790.00 / $4,048.28 / $4,422.06
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Low / Median / High Price
$993.07 / $1,418.67 / $2,122.82
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$76.37 / $877.87 / $1,425.42
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,050.00 / $6,227.00 / $9,483.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.50 / $1,299.49 / $2,243.40