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Cleft Palate Repair With Gum Ridge Bone Graft

Ohio 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 $6,026 · 10th–90th $1,622$12,5890%10%10th90th$6,026Professionalmedian $1,148 · 10th–90th $933$2,1380%20%40%10th90th$1,148$10.0$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
$2,089.30
Median
$8,912.51
Typical High
$12,589.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$6,025.60
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$3,715.35
Typical High
$16,982.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,122.02
Typical High
$1,819.70
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,148.15
Typical High
$3,630.78
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,258.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$1,698.24
Typical High
$4,897.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,380.38
Typical High
$2,290.87
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$1,819.70
Typical High
$21,379.62
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$457.09
Median
$1,380.38
Typical High
$2,238.72
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$9,120.11
Median
$9,120.11
Typical High
$9,120.11
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$2,187.76
United
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$5,754.40
Typical High
$11,748.98
United
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,202.26
Typical High
$2,041.74