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Cleft Palate Repair With Gum Ridge Bone Graft

Montana 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 $1,862 · 10th–90th $1,259$3,2360%20%40%10th90th$1,862Professionalmedian $1,413 · 10th–90th $977$2,7540%20%10th90th$1,413$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
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,096.48
Typical High
$2,754.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,698.24
Typical High
$1,698.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,479.11
Typical High
$3,235.94
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$1,862.09
Typical High
$2,290.87
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$1,819.70
Median
$1,862.09
Typical High
$2,290.87
Providence
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,548.82
Typical High
$2,754.23
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$1,698.24
Typical High
$2,884.03
United
Setting
Facility
Modifier
Global
Typical Low
$1,258.93
Median
$1,258.93
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$1,737.80
Typical High
$2,290.87