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Cleft Palate Repair With Gum Ridge Bone Graft

Louisiana 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 $3,236 · 10th–90th $1,023$9,7720%5%10%10th90th$3,236Professionalmedian $1,259 · 10th–90th $977$2,0420%10%20%10th90th$1,259$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
$933.25
Median
$2,691.53
Typical High
$6,606.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$2,089.30
BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,466.84
Median
$8,709.64
Typical High
$12,302.69
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,513.56
Typical High
$1,778.28
Christus
Setting
Facility
Modifier
Global
Typical Low
$39.81
Median
$954.99
Typical High
$2,818.38
Cigna
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$1,148.15
Typical High
$4,265.80
Cigna
Setting
Professional
Modifier
Global
Typical Low
$512.86
Median
$1,380.38
Typical High
$2,511.89
United
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$5,495.41
Typical High
$11,748.98
United
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,202.26
Typical High
$1,995.26