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Cleft Palate Repair With Gum Ridge Bone Graft

Arizona 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 $4,677 · 10th–90th $1,122$8,3180%5%10%10th90th$4,677Professionalmedian $1,148 · 10th–90th $977$2,5120%10%20%10th90th$1,148$500.0$1.0K$2.0K$5.0K$10.0K$20.0K

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
$2,238.72
Median
$5,011.87
Typical High
$9,772.37
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$2,137.96
BCBS
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$3,715.35
Typical High
$7,244.36
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,318.26
Typical High
$2,290.87
Cigna
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$3,311.31
Typical High
$5,370.32
Cigna
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,230.27
Typical High
$2,238.72
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,288.25
Typical High
$6,760.83
Medica
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,348.96
Typical High
$11,481.54
United
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$5,495.41
Typical High
$8,709.64
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,148.15
Typical High
$2,041.74