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Cleft Palate Repair With Gum Ridge Bone Graft

Kentucky 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 $4,365 · 10th–90th $1,622$11,4820%5%10th90th$4,365Professionalmedian $1,072 · 10th–90th $933$1,5490%20%10th90th$1,072$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
$851.14
Median
$3,630.78
Typical High
$10,471.29
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,071.52
Typical High
$1,479.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,398.83
Median
$4,466.84
Typical High
$12,022.64
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,071.52
Typical High
$1,412.54
CareSource
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$1,122.02
Typical High
$1,584.89
CareSource
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,174.90
Typical High
$1,584.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,698.24
Typical High
$2,511.89
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,479.11
Typical High
$9,549.93
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$1,000.00
United
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$4,677.35
Typical High
$10,471.29
United
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,288.25
Typical High
$2,041.74