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Cleft Palate Repair With Gum Ridge Bone Graft

Indiana 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 $15,136 · 10th–90th $2,239$25,7040%10%10th90th$15,136Professionalmedian $1,148 · 10th–90th $977$1,7780%20%10th90th$1,148$500.0$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
$1,174.90
Median
$4,897.79
Typical High
$18,620.87
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,096.48
Typical High
$1,548.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,570.88
Median
$15,488.17
Typical High
$25,703.96
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,258.93
Typical High
$1,995.26
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,071.52
Typical High
$1,202.26
CareSource
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$912.01
Typical High
$912.01
Cigna
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,698.24
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,412.54
Typical High
$2,238.72
United
Setting
Facility
Modifier
Global
Typical Low
$3,388.44
Median
$9,549.93
Typical High
$15,848.93
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,174.90
Typical High
$1,905.46