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Cleft Palate Repair With Gum Ridge Bone Graft

Oregon 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 $1,995 · 10th–90th $1,096$13,4900%20%10th90th$1,995Professionalmedian $1,950 · 10th–90th $1,047$2,9510%10%20%10th90th$1,950$20.0$200.0$2.0K$20.0K$200.0K

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
$2,754.23
Median
$13,803.84
Typical High
$21,379.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,288.25
Typical High
$3,388.44
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,344.23
Median
$2,344.23
Typical High
$5,011.87
Cigna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,949.84
Typical High
$2,884.03
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,041.74
Typical High
$2,398.83
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,479.11
Typical High
$2,511.89
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,584.89
Median
$1,949.84
Typical High
$2,630.27
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,348.96
Median
$2,089.30
Typical High
$2,187.76
Providence
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,513.56
Typical High
$2,570.40
Providence
Setting
Professional
Modifier
Global
Typical Low
$79.43
Median
$2,089.30
Typical High
$2,884.03
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$14,125.38
Median
$19,054.61
Typical High
$23,442.29
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,995.26
Median
$2,511.89
Typical High
$3,019.95
United
Setting
Facility
Modifier
Global
Typical Low
$2,238.72
Median
$16,218.10
Typical High
$22,908.68
United
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$2,041.74
Typical High
$3,019.95