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Cleft Palate Repair With Gum Ridge Bone Graft

South Carolina 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 $4,571 · 10th–90th $1,202$20,4170%5%10%10th90th$4,571Professionalmedian $1,230 · 10th–90th $1,000$2,4550%20%10th90th$1,230$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
$1,258.93
Median
$14,791.08
Typical High
$21,877.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,230.27
Typical High
$2,754.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$10,471.29
Typical High
$17,782.79
BCBS
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,258.93
Typical High
$1,995.26
Cigna
Setting
Facility
Modifier
Global
Typical Low
$562.34
Median
$912.01
Typical High
$3,715.35
Cigna
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,380.38
Typical High
$2,630.27
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,380.38
Median
$1,479.11
Typical High
$1,778.28
Medcost
Setting
Facility
Modifier
Global
Typical Low
$1,071.52
Median
$1,445.44
Typical High
$2,398.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$2,884.03
Median
$16,218.10
Typical High
$25,703.96
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,202.26
Typical High
$2,089.30