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Cleft Palate Repair With Gum Ridge Bone Graft

New Hampshire 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 $5,495 · 10th–90th $871$15,8490%10%10th90th$5,495Professionalmedian $1,622 · 10th–90th $1,047$2,6300%10%10th90th$1,622$100.0$500.0$2.0K$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
$100.00
Median
$3,801.89
Typical High
$15,848.93
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$1,548.82
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$5,623.41
Typical High
$8,912.51
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$2,137.96
Typical High
$3,090.30
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,951.21
Median
$2,951.21
Typical High
$2,951.21
Cigna
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$1,548.82
Typical High
$2,754.23
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$4,570.88
Typical High
$11,220.18
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$1,148.15
Median
$1,621.81
Typical High
$2,570.40
United
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$4,570.88
Typical High
$11,220.18
United
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,737.80
Typical High
$3,388.44
Well Sense
Setting
Facility
Modifier
Global
Typical Low
$707.95
Median
$812.83
Typical High
$1,288.25