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Rhode Island 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
$3,438.26 / $3,706.14 / $4,026.21
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.36 / $1,079.21 / $1,547.47
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,138.54 / $1,444.73 / $2,010.66
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$956.00 / $956.00 / $5,421.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$855.13 / $1,670.15 / $2,539.90
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,219.00 / $5,979.00 / $12,680.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,014.80 / $1,358.06 / $2,302.55