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Cleft Palate Repair Surgery

Massachusetts rates for HCPCS 42200

This surgery repairs a cleft palate, a birth condition in which the roof of the mouth did not fully join together during development, leaving a gap between the mouth and nasal cavity. The surgeon closes the opening in the soft palate, hard palate, or both, restoring a continuous roof of the mouth to support normal speech, feeding, and swallowing. It's typically performed on infants or young children born with this condition.

Rates data updated July 2026.

How much does Cleft Palate Repair Surgery cost?

$4,510

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

Insurers have agreed to pay about $4,510 for this procedure. That total is two separate charges: $1,122 to the doctor who performs it, and $3,388 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$1,122$933 to $1,905
Facility feeThe hospital or surgery center$3,388$2,512 to $5,370

How much rates vary

Facilitymedian $3,388 · 10th to 90th $933 to $8,913Professionalmedian $1,122 · 10th to 90th $851 to $2,884
$100.0$1.0K$10.0Kfacility $3,388professional $1,122

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
$1,258.93
Median
$3,630.78
Typical High
$6,456.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$794.33
Median
$954.99
Typical High
$3,090.30
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$4,897.79
Typical High
$16,982.44
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,445.44
Typical High
$9,772.37
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$1,862.09
Typical High
$2,570.40
Cigna
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$1,023.29
Typical High
$6,456.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$1,202.26
Typical High
$2,454.71
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$1,202.26
Typical High
$3,311.31
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,148.15
Typical High
$1,778.28
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$5,011.87
Typical High
$13,182.57
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,548.82
Typical High
$2,398.83
Health New England
Setting
Facility
Modifier
Global
Typical Low
$5,623.41
Median
$5,623.41
Typical High
$5,623.41
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$4,897.79
Typical High
$16,982.44
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,445.44
Typical High
$9,772.37
United
Setting
Facility
Modifier
Global
Typical Low
$1,479.11
Median
$5,011.87
Typical High
$13,489.63
United
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,548.82
Typical High
$2,754.23

Where Massachusetts sits

The same service costs 7.3 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 feeMassachusetts $4,510 · 35th of 50
IN $13,860WV $1,889

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.