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Cleft Palate Repair With Gum Ridge Bone Graft

Georgia 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 $4,571 · 10th–90th $1,175$10,0000%5%10%10th90th$4,571Professionalmedian $1,318 · 10th–90th $1,000$2,3990%10%10th90th$1,318$100.0$500.0$2.0K$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
$1,778.28
Median
$5,370.32
Typical High
$10,232.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,230.27
Typical High
$2,344.23
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$3,388.44
Typical High
$7,762.47
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,737.80
Typical High
$2,691.53
CareSource
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
Cigna
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$1,174.90
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,479.11
Typical High
$2,454.71
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,288.25
Typical High
$2,951.21
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,148.15
Typical High
$1,148.15
United
Setting
Facility
Modifier
Global
Typical Low
$758.58
Median
$5,370.32
Typical High
$10,471.29
United
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,318.26
Typical High
$2,398.83