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Repair Of A Tear In The Roof Of The Mouth

Pennsylvania rates for HCPCS 42182

This procedure surgically closes a tear or wound in the roof of the mouth, called the palate. The surgeon cleans the area and stitches the tissue layers back together to restore a normal palate. It is typically needed after an injury, such as a fall or puncture wound, rather than a birth defect.

Rates data updated July 2026.

How much does Repair Of A Tear In The Roof Of The Mouth cost?

$4,207

Typical total for the visit. In Pennsylvania, July 2026.

Insurers have agreed to pay about $4,207 for this procedure. That total is two separate charges: $316 to the doctor who performs it, and $3,890 to the hospital or surgery center where it takes place. Done somewhere without a facility charge, you pay only the first.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 9 insurance carriers under federal price transparency rules.

What's inside this number

Part of the billTypicalRange
Physician feeThe doctor who performs it$316$269 to $363
Facility feeThe hospital or surgery center$3,890$1,660 to $5,370

How much rates vary

Facilitymedian $3,890 · 10th to 90th $589 to $8,318Professionalmedian $316 · 10th to 90th $245 to $479
$10.0$100.0$1.0K$10.0Kfacility $3,890professional $316

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$588.84
Median
$3,890.45
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$309.03
Typical High
$467.74
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$9,549.93
Median
$10,000.00
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$363.08
Median
$398.11
Typical High
$398.11
Cigna
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$4,168.69
Typical High
$8,128.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$346.74
Typical High
$575.44
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$512.86
Typical High
$512.86
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$389.05
Median
$478.63
Typical High
$724.44
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$4,365.16
Typical High
$5,248.07
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$281.84
Median
$346.74
Typical High
$562.34
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$3,235.94
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$331.13
Typical High
$954.99
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$354.81
Median
$371.54
Typical High
$758.58
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$269.15
Median
$1,412.54
Typical High
$2,884.03
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$251.19
Median
$275.42
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$3,311.31
Typical High
$17,378.01
United
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$323.59
Typical High
$549.54

Where Pennsylvania sits

The same service costs 18.0 times more in Indiana than in West Virginia. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Physician feeFacility feePennsylvania $4,207 · 14th of 50
IN $11,288WV $626

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.