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Cleft Palate Repair With Gum Ridge Bone Graft

Arkansas rates for HCPCS 42210

Closes a cleft in the roof of the mouth and rebuilds the gap in the gum ridge that holds the teeth, using a piece of the patient's own bone taken during the same operation. Filling the gum ridge gives the teeth a base to sit in and supports the shape of the upper jaw. It is usually done in childhood, timed around dental development.

Rates data updated July 2026.

Facilitymedian $2,344 · 10th–90th $1,318$6,6070%10%20%10th90th$2,344Professionalmedian $1,148 · 10th–90th $977$1,6220%20%10th90th$1,148$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$1,819.70
Typical High
$2,818.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,122.02
Typical High
$1,445.44
BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,370.32
Median
$5,370.32
Typical High
$7,413.10
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,513.56
Cigna
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$794.33
Typical High
$4,365.16
Cigna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,412.54
Typical High
$1,949.84
United
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$3,981.07
Typical High
$11,748.98
United
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,258.93
Typical High
$2,041.74