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Cleft Palate Repair With Gum Ridge Bone Graft

Connecticut 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 $8,511 · 10th–90th $4,677$14,1250%10%10th90th$8,511Professionalmedian $1,259 · 10th–90th $977$2,7540%10%10th90th$1,259$50.0$200.0$1.0K$5.0K$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
$4,570.88
Median
$7,943.28
Typical High
$13,489.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$2,754.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$8,317.64
Median
$14,125.38
Typical High
$16,595.87
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,995.26
Typical High
$2,754.23
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$5,888.44
Typical High
$8,317.64
Cigna
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,621.81
Typical High
$2,884.03
ConnectiCare
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$1,174.90
Typical High
$1,174.90
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,659.59
Typical High
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$9,772.37
Typical High
$16,218.10
United
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,778.28
Typical High
$3,801.89