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Cleft Palate Repair With Gum Ridge Bone Graft

Tennessee 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 $4,266 · 10th–90th $1,318$10,2330%5%10%10th90th$4,266Professionalmedian $1,175 · 10th–90th $977$2,2390%20%10th90th$1,175$500.0$1.0K$2.0K$5.0K$10.0K$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
$2,951.21
Typical High
$6,456.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,148.15
Typical High
$1,905.46
BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,454.71
Median
$6,165.95
Typical High
$9,772.37
BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,584.89
Typical High
$2,398.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$724.44
Median
$3,548.13
Typical High
$6,309.57
Cigna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,288.25
Typical High
$2,238.72
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$16,982.44
Median
$16,982.44
Typical High
$42,657.95
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$12,022.64
Median
$12,022.64
Typical High
$12,022.64
United
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$5,370.32
Typical High
$10,000.00
United
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,258.93
Typical High
$2,137.96