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Cleft Palate Repair With Gum Ridge Bone Graft

Pennsylvania 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 $1,288$10,7150%10%10th90th$6,026Professionalmedian $1,122 · 10th–90th $977$1,7780%50%10th90th$1,122$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
$1,148.15
Median
$6,165.95
Typical High
$10,715.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,122.02
Typical High
$1,548.82
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$9,549.93
Median
$10,000.00
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$1,513.56
Median
$1,659.59
Typical High
$1,819.70
Cigna
Setting
Facility
Modifier
Global
Typical Low
$741.31
Median
$3,235.94
Typical High
$8,128.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,230.27
Typical High
$2,137.96
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$2,187.76
Typical High
$2,187.76
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,412.54
Typical High
$1,995.26
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$3,311.31
Median
$4,786.30
Typical High
$5,370.32
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,122.02
Typical High
$1,819.70
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$11,748.98
Median
$19,054.61
Typical High
$46,773.51
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$5,495.41
Typical High
$10,471.29
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,122.02
Typical High
$3,019.95
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,148.15
Typical High
$2,344.23
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$2,884.03
Typical High
$4,897.79
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,047.13
Typical High
$1,122.02
United
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$4,677.35
Typical High
$17,378.01
United
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,202.26
Typical High
$2,089.30