go back

Cleft Palate Repair With Gum Ridge Bone Graft

Rhode Island 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 $5,370 · 10th–90th $1,288$13,1830%10%10th90th$5,370Professionalmedian $1,349 · 10th–90th $1,000$1,5490%20%40%10th90th$1,349$500.0$1.0K$2.0K$5.0K$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
$3,467.37
Median
$3,715.35
Typical High
$3,981.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,348.96
Typical High
$1,513.56
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,445.44
Typical High
$2,137.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$5,370.32
Cigna
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,548.82
Typical High
$2,511.89
United
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$7,244.36
Typical High
$13,182.57
United
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,258.93
Typical High
$2,290.87