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Cleft Palate Repair With Gum Ridge Bone Graft

Virginia 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 $1,862 · 10th–90th $1,096$10,9650%5%10%10th90th$1,862Professionalmedian $1,230 · 10th–90th $1,000$2,1380%10%20%10th90th$1,230$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
$1,548.82
Median
$5,888.44
Typical High
$12,589.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,230.27
Typical High
$2,137.96
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$7,413.10
Typical High
$9,332.54
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,348.96
Typical High
$2,137.96
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,122.02
Typical High
$2,951.21
Cigna
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$2,951.21
Typical High
$3,890.45
Cigna
Setting
Professional
Modifier
Global
Typical Low
$870.96
Median
$1,288.25
Typical High
$2,041.74
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$912.01
Median
$1,122.02
Typical High
$1,905.46
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,445.44
Median
$1,479.11
Typical High
$2,398.83
Medcost
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$1,412.54
Typical High
$2,187.76
Medcost
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,288.25
Typical High
$2,238.72
Sentara
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,288.25
Typical High
$4,786.30
Sentara
Setting
Professional
Modifier
Global
Typical Low
$1,023.29
Median
$1,288.25
Typical High
$4,786.30
United
Setting
Facility
Modifier
Global
Typical Low
$2,187.76
Median
$10,000.00
Typical High
$21,877.62
United
Setting
Professional
Modifier
Global
Typical Low
$851.14
Median
$1,258.93
Typical High
$2,137.96