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Cleft Palate Repair With Gum Ridge Bone Graft

North Carolina 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 $1,738 · 10th–90th $1,047$12,0230%10%10th90th$1,738Professionalmedian $1,738 · 10th–90th $1,047$3,0900%10%20%10th90th$1,738$1.0$10.0$100.0$1.0K$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
$1,445.44
Median
$7,762.47
Typical High
$12,589.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,174.90
Typical High
$2,754.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,818.38
Median
$3,235.94
Typical High
$3,630.78
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$2,238.72
Typical High
$3,162.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$3,467.37
Typical High
$5,623.41
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,513.56
Typical High
$2,691.53
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,778.28
Median
$1,778.28
Typical High
$1,778.28
Medcost
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,348.96
Typical High
$2,137.96
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$2,884.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,148.15
United
Setting
Facility
Modifier
Global
Typical Low
$1,513.56
Median
$7,762.47
Typical High
$19,054.61
United
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,174.90
Typical High
$2,089.30
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$16,982.44
Median
$16,982.44
Typical High
$42,657.95
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$12,022.64
Median
$12,022.64
Typical High
$12,022.64