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Cleft Palate Repair With Gum Ridge Bone Graft

Maine 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 $977 · 10th–90th $977$12,0230%20%40%90th$977Professionalmedian $1,318 · 10th–90th $1,096$2,5700%10%10th90th$1,318$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. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,148.15
Typical High
$1,318.26
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,659.59
Typical High
$2,511.89
Cigna
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,412.54
Typical High
$2,511.89
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$1,584.89
Typical High
$2,754.23
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,258.93
Typical High
$2,290.87
United
Setting
Facility
Modifier
Global
Typical Low
$12,022.64
Median
$12,022.64
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,548.82
Typical High
$2,884.03