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Cleft Palate Repair With Gum Ridge Bone Graft

Hawaii 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 $2,818 · 10th–90th $1,862$6,0260%20%40%10th90th$2,818Professionalmedian $1,318 · 10th–90th $977$8,3180%10%10th90th$1,318$50.0$200.0$1.0K$5.0K

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
$1,862.09
Median
$2,818.38
Typical High
$6,025.60
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,096.48
Typical High
$1,548.82
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,737.80
Median
$1,737.80
Typical High
$1,737.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,380.38
Typical High
$2,951.21
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,174.90
Typical High
$1,479.11
United
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$3,019.95
Typical High
$3,019.95
United
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,288.25
Typical High
$1,778.28
University Health Alliance
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$4,677.35
Typical High
$9,332.54