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Cleft Palate Repair Surgery

Maryland 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 October 2026.

How much does Cleft Palate Repair Surgery cost?

$977

Typical physician fee. In Maryland, October 2026.

Insurers have agreed to pay about $977 for this service. Most negotiated rates run $871 to $1,096.

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 6 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $2,951 · 10th to 90th $759 to $5,495Professionalmedian $977 · 10th to 90th $708 to $1,259
$1K$2K$5Kfacility $2,951professional $977

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$977.24
Median
$1,047.13
Typical High
$1,096.48
CareFirst
Setting
Professional
Modifier
None
Typical Low
$870.96
Median
$977.24
Typical High
$1,202.26
Cigna
Setting
Facility
Modifier
None
Typical Low
$707.95
Median
$3,090.30
Typical High
$5,011.87
Cigna
Setting
Professional
Modifier
None
Typical Low
$831.76
Median
$977.24
Typical High
$1,412.54
Kaiser Permanente
Setting
Professional
Modifier
None
Typical Low
$851.14
Median
$933.25
Typical High
$1,412.54
United
Setting
Facility
Modifier
None
Typical Low
$1,288.25
Median
$2,511.89
Typical High
$5,754.40
United
Setting
Professional
Modifier
None
Typical Low
$691.83
Median
$912.01
Typical High
$1,737.80
Wellpoint
Setting
Professional
Modifier
None
Typical Low
$691.83
Median
$691.83
Typical High
$1,148.15
6 more rates with less common billing modifiers

A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.

Insurance Carrier
Aetna
Setting
Professional
Modifier
52 · Reduced service
Typical Low
$524.81
Median
$524.81
Typical High
$549.54
Aetna
Setting
Professional
Modifier
53 · Discontinued
Typical Low
$208.93
Median
$208.93
Typical High
$218.78
Aetna
Setting
Professional
Modifier
54 · Surgery only
Typical Low
$794.33
Median
$794.33
Typical High
$831.76
Aetna
Setting
Professional
Modifier
55 · Aftercare only
Typical Low
$158.49
Median
$158.49
Typical High
$165.96
Aetna
Setting
Professional
Modifier
56 · Pre-op care only
Typical Low
$104.71
Median
$104.71
Typical High
$109.65
Aetna
Setting
Professional
Modifier
78 · Unplanned return to OR
Typical Low
$741.31
Median
$741.31
Typical High
$776.25

Where Maryland sits

The same service costs 6.0 times more in Alaska than in Texas. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Maryland· 39th of 51

$977

AK $3,802TX $631

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.