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Cleft Palate Repair With Gum Ridge Bone Graft

Utah 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 $6,918 · 10th–90th $1,950$9,7720%10%20%10th90th$6,918Professionalmedian $1,413 · 10th–90th $1,000$3,1620%10%10th90th$1,413$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
$1,412.54
Median
$6,918.31
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,412.54
Typical High
$5,888.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$524.81
Median
$1,318.26
Typical High
$2,238.72
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$2,344.23
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$8,511.38
Median
$11,481.54
Typical High
$17,782.79
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,318.26
Median
$1,659.59
Typical High
$2,137.96
Select Health
Setting
Facility
Modifier
Global
Typical Low
$1,949.84
Median
$1,949.84
Typical High
$1,949.84
Select Health
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,737.80
Typical High
$2,041.74
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,584.89
Typical High
$2,290.87
United
Setting
Facility
Modifier
Global
Typical Low
$1,202.26
Median
$5,128.61
Typical High
$13,803.84
United
Setting
Professional
Modifier
Global
Typical Low
$954.99
Median
$1,202.26
Typical High
$1,949.84