go back

Cleft Palate Repair With Gum Ridge Bone Graft

Washington, DC 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 $5,495 · 10th–90th $1,413$7,7620%10%20%10th90th$5,495Professionalmedian $1,148 · 10th–90th $977$1,5490%20%10th90th$1,148$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
$1,412.54
Median
$5,495.41
Typical High
$7,079.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,148.15
Typical High
$1,258.93
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,148.15
Typical High
$9,772.37
Cigna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,288.25
Typical High
$3,019.95
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,071.52
Typical High
$2,238.72
United
Setting
Facility
Modifier
Global
Typical Low
$3,235.94
Median
$13,182.57
Typical High
$34,673.69
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,288.25
Typical High
$2,630.27