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Texas 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
$1,017.00 / $3,682.00 / $12,281.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.36 / $1,107.29 / $1,684.20
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,880.42 / $7,275.80 / $14,551.59
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$913.38 / $1,202.28 / $1,750.53
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$946.28 / $946.28 / $960.95
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,847.00 / $3,795.09 / $4,927.06
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,018.13 / $1,414.85 / $2,217.52
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$11,500.00 / $16,547.20 / $26,542.00
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$11,430.60 / $11,430.60 / $11,430.60
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,043.86 / $1,324.18 / $2,423.50
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,210.81 / $1,610.91 / $1,958.36
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$6.00 / $1,531.10 / $2,756.60
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,043.86 / $1,333.95 / $2,498.44
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,051.59 / $1,513.62 / $2,689.81
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,093.00 / $5,870.00 / $13,237.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$863.72 / $1,189.20 / $1,870.51
Wellpoint
Facility/Professional
Professional
Modifier
Low / Median / High Price
$898.60 / $1,048.52 / $1,418.30