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Utah 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
$1,414.16 / $6,905.21 / $8,194.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$992.36 / $1,223.48 / $3,118.24
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,061.34 / $1,478.50 / $2,237.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$61.32 / $714.57 / $1,034.34
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,413.68 / $11,103.62 / $16,181.16
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,405.97 / $1,713.89 / $2,225.46
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,912.00 / $7,693.00 / $13,847.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$965.31 / $1,236.30 / $2,352.00