go back

Cleft Palate Repair With Gum Ridge Bone Graft

Texas 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 $3,715 · 10th–90th $1,096$12,8820%5%10th90th$3,715Professionalmedian $1,148 · 10th–90th $977$1,9050%20%10th90th$1,148$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
$1,096.48
Median
$3,890.45
Typical High
$12,882.50
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,148.15
Typical High
$1,737.80
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,981.07
Median
$7,585.78
Typical High
$14,791.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,148.15
Typical High
$1,659.59
Christus
Setting
Facility
Modifier
Global
Typical Low
$954.99
Median
$954.99
Typical High
$1,000.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$3,548.13
Typical High
$4,365.16
Cigna
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,348.96
Typical High
$2,290.87
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$16,982.44
Median
$42,657.95
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
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,380.38
Typical High
$2,454.71
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$1,445.44
Typical High
$2,137.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$912.01
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,096.48
Typical High
$1,148.15
Providence
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,380.38
Typical High
$2,511.89
Providence
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,380.38
Typical High
$2,398.83
United
Setting
Facility
Modifier
Global
Typical Low
$2,089.30
Median
$5,754.40
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,202.26
Typical High
$1,819.70
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$933.25
Typical High
$1,288.25