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Cleft Palate Repair With Gum Ridge Bone Graft

Michigan 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 $5,754 · 10th–90th $1,380$13,4900%20%10th90th$5,754Professionalmedian $1,175 · 10th–90th $977$1,6220%10%20%10th90th$1,175$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
$4,897.79
Median
$5,754.40
Typical High
$13,489.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$1,548.82
BCBS
Setting
Facility
Modifier
Global
Typical Low
$302.00
Median
$302.00
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,513.56
Typical High
$1,621.81
Cigna
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,288.25
Typical High
$2,630.27
Health Alliance Plan
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$3,388.44
Typical High
$5,754.40
Health Alliance Plan
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,230.27
Typical High
$1,737.80
Priority Health
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$2,290.87
Typical High
$4,466.84
United
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$7,762.47
Typical High
$14,791.08
United
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,318.26
Typical High
$1,905.46