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Cleft Palate Repair With Gum Ridge Bone Graft

Minnesota 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 $4,365 · 10th–90th $1,259$17,3780%10%10th90th$4,365Professionalmedian $2,455 · 10th–90th $1,096$3,8900%10%10th90th$2,455$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
$1,000.00
Median
$1,000.00
Typical High
$6,606.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,148.15
Typical High
$2,691.53
BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$13,182.57
Typical High
$26,915.35
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,698.24
Median
$2,754.23
Typical High
$3,890.45
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$3,801.89
Typical High
$10,471.29
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,737.80
Median
$2,951.21
Typical High
$4,570.88
Health Partners
Setting
Facility
Modifier
Global
Typical Low
$2,884.03
Median
$3,715.35
Typical High
$8,128.31
Health Partners
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,630.27
Typical High
$4,168.69
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,698.24
Typical High
$3,890.45
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$2,041.74
Typical High
$11,481.54
United
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$8,709.64
Typical High
$15,135.61
United
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,905.46
Typical High
$3,715.35