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Cleft Palate Repair With Gum Ridge Bone Graft

Maryland 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 $2,754 · 10th–90th $1,230$6,0260%10%10th90th$2,754Professionalmedian $1,148 · 10th–90th $977$2,2910%20%10th90th$1,148$500.0$1.0K$2.0K$5.0K$10.0K

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
$1,230.27
Median
$3,235.94
Typical High
$8,912.51
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,122.02
Typical High
$2,754.23
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,122.02
Typical High
$1,659.59
Cigna
Setting
Facility
Modifier
Global
Typical Low
$812.83
Median
$3,090.30
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,258.93
Typical High
$2,089.30
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,122.02
Typical High
$1,621.81
United
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$1,862.09
Typical High
$3,715.35
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,258.93
Typical High
$2,290.87
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,174.90
Typical High
$1,445.44