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Cleft Palate Repair With Gum Ridge Bone Graft

Oklahoma 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 $6,607 · 10th–90th $1,230$18,6210%5%10th90th$6,607Professionalmedian $1,096 · 10th–90th $977$1,8200%20%10th90th$1,096$500.0$1.0K$2.0K$5.0K$10.0K$20.0K$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
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$2,041.74
Typical High
$8,128.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,096.48
Typical High
$1,659.59
BCBS
Setting
Facility
Modifier
Global
Typical Low
$8,912.51
Median
$13,489.63
Typical High
$22,908.68
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,288.25
Typical High
$1,479.11
Cigna
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$1,230.27
Typical High
$1,698.24
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,548.82
Typical High
$8,128.31
Medica
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,258.93
Typical High
$11,481.54
United
Setting
Facility
Modifier
Global
Typical Low
$1,621.81
Median
$5,370.32
Typical High
$10,964.78
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,202.26
Typical High
$1,737.80