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Cleft Palate Repair With Gum Ridge Bone Graft

Idaho 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 $2,512 · 10th–90th $1,175$11,7490%5%10%10th90th$2,512Professionalmedian $1,514 · 10th–90th $1,047$2,7540%10%20%10th90th$1,514$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
$4,466.84
Median
$8,511.38
Typical High
$10,000.00
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,148.15
Typical High
$3,090.30
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$6,606.93
Typical High
$15,135.61
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$2,041.74
Typical High
$2,137.96
Cigna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,584.89
Typical High
$2,041.74
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$1,548.82
Typical High
$2,818.38
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,778.28
Typical High
$2,187.76
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$891.25
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$9,772.37
Median
$13,182.57
Typical High
$19,054.61
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$2,089.30
Typical High
$2,454.71
Select Health
Setting
Facility
Modifier
Global
Typical Low
$891.25
Median
$7,762.47
Typical High
$12,589.25
Select Health
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$891.25
Typical High
$1,995.26
United
Setting
Facility
Modifier
Global
Typical Low
$10,232.93
Median
$22,387.21
Typical High
$27,542.29
United
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,513.56
Typical High
$2,187.76