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Cleft Palate Repair With Gum Ridge Bone Graft

Nebraska 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 $7,943 · 10th–90th $1,549$15,4880%10%20%10th90th$7,943Professionalmedian $1,202 · 10th–90th $977$3,0900%10%20%10th90th$1,202$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. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$7,079.46
Median
$8,511.38
Typical High
$15,135.61
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$3,090.30
BCBS
Setting
Facility
Modifier
Global
Typical Low
$11,748.98
Median
$15,488.17
Typical High
$30,199.52
BCBS
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,621.81
Typical High
$2,344.23
Cigna
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$2,041.74
Typical High
$3,235.94
Medica
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$1,659.59
Typical High
$7,413.10
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$2,041.74
Typical High
$11,481.54
Midlands
Setting
Professional
Modifier
Global
Typical Low
$2,041.74
Median
$2,511.89
Typical High
$3,311.31
Midlands
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,137.96
Typical High
$3,311.31
United
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$6,918.31
Typical High
$9,120.11
United
Setting
Professional
Modifier
Global
Typical Low
$1,202.26
Median
$1,778.28
Typical High
$2,754.23