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Cleft Palate Repair With Gum Ridge Closure

Kentucky rates for HCPCS 42205

This surgery repairs an opening in the roof of the mouth present from birth and also closes the cleft in the gum ridge using the patient's own tissue, without adding bone graft material. It is typically performed in infancy or childhood to restore normal separation between the mouth and nasal cavity.

Rates data updated July 2026.

How much does Cleft Palate Repair With Gum Ridge Closure cost?

$1,000

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $1,000 for this service. The price depends on where it is billed: about $955 from a physician practice, and about $4,365 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

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.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$955$832 to $1,148
FacilityA hospital or hospital-owned outpatient department$4,365$2,951 to $8,511

How much rates vary

Facilitymedian $4,365 · 10th to 90th $1,514 to $11,482Professionalmedian $955 · 10th to 90th $776 to $1,349
$50.0$200.0$1.0K$5.0Kfacility $4,365professional $955

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
$851.14
Median
$3,630.78
Typical High
$10,471.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$954.99
Typical High
$1,318.26
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$4,466.84
Typical High
$12,022.64
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$794.33
Typical High
$1,230.27
CareSource
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$1,023.29
Typical High
$1,412.54
CareSource
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,071.52
Typical High
$1,412.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$1,513.56
Typical High
$2,511.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,318.26
Typical High
$5,495.41
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$912.01
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$4,677.35
Typical High
$10,000.00
United
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,148.15
Typical High
$1,778.28

Where Kentucky sits

The same service costs 2.8 times more in California than in West Virginia. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Kentucky $1,000 · 50th of 51
CA $2,630WV $955

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.