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Cleft Palate Repair With Gum Ridge Bone Graft

Massachusetts 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 $3,388 · 10th–90th $1,072$9,5500%5%10%10th90th$3,388Professionalmedian $1,288 · 10th–90th $1,000$3,1620%10%20%10th90th$1,288$100.0$500.0$2.0K$10.0K$50.0K

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
$2,511.89
Median
$3,630.78
Typical High
$6,918.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,096.48
Typical High
$3,019.95
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$4,897.79
Typical High
$16,982.44
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,659.59
Typical High
$12,022.64
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$2,187.76
Typical High
$2,951.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$1,023.29
Typical High
$6,456.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$1,445.44
Typical High
$2,818.38
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$1,380.38
Typical High
$3,311.31
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,318.26
Typical High
$2,041.74
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$5,011.87
Typical High
$13,182.57
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,778.28
Typical High
$2,754.23
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$1,905.46
Median
$4,897.79
Typical High
$16,982.44
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,659.59
Typical High
$12,022.64
United
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$5,011.87
Typical High
$13,489.63
United
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,819.70
Typical High
$3,162.28