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Cleft Palate Repair With Gum Ridge Bone Graft

Washington 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 $2,692 · 10th–90th $1,380$19,9530%10%10th90th$2,692Professionalmedian $1,514 · 10th–90th $977$3,0900%20%10th90th$1,514$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
$1,513.56
Median
$7,943.28
Typical High
$21,877.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,230.27
Typical High
$2,951.21
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$10,715.19
Median
$18,197.01
Typical High
$32,359.37
Asuris Northwest Health
Setting
Professional
Modifier
Global
Typical Low
$1,548.82
Median
$2,041.74
Typical High
$2,691.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,258.93
Typical High
$8,317.64
Cigna
Setting
Professional
Modifier
Global
Typical Low
$776.25
Median
$1,659.59
Typical High
$3,235.94
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$1,230.27
Median
$2,344.23
Typical High
$7,943.28
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$2,041.74
Typical High
$3,981.07
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$478.63
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,479.11
Median
$2,089.30
Typical High
$2,187.76
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,445.44
Median
$1,479.11
Typical High
$5,888.44
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,479.11
Median
$2,089.30
Typical High
$3,090.30
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$10,964.78
Median
$17,378.01
Typical High
$31,622.78
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$1,621.81
Median
$2,089.30
Typical High
$2,754.23
United
Setting
Facility
Modifier
Global
Typical Low
$3,019.95
Median
$16,982.44
Typical High
$33,113.11
United
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,584.89
Typical High
$2,818.38
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$933.25
Median
$1,071.52
Typical High
$2,041.74