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Cleft Palate Repair With Gum Ridge Bone Graft

Wisconsin 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 $9,772 · 10th–90th $1,380$16,9820%5%10%10th90th$9,772Professionalmedian $1,549 · 10th–90th $1,000$4,8980%10%10th90th$1,549$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
$1,174.90
Median
$3,890.45
Typical High
$9,332.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$1,000.00
Median
$1,148.15
Typical High
$3,467.37
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$10,964.78
Typical High
$18,197.01
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$1,071.52
Median
$1,995.26
Typical High
$5,248.07
Cigna
Setting
Facility
Modifier
Global
Typical Low
$2,818.38
Median
$3,235.94
Typical High
$5,248.07
Cigna
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$2,630.27
Typical High
$4,466.84
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,513.56
Typical High
$6,309.57
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$1,862.09
Median
$2,290.87
Typical High
$3,630.78
Medica
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$1,659.59
Typical High
$13,489.63
Medica
Setting
Professional
Modifier
Global
Typical Low
$1,096.48
Median
$1,905.46
Typical High
$11,481.54
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$70.79
Network Health
Setting
Facility
Modifier
Global
Typical Low
$2,041.74
Median
$9,332.54
Typical High
$15,848.93
Network Health
Setting
Professional
Modifier
Global
Typical Low
$1,174.90
Median
$2,398.83
Typical High
$4,168.69
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$1,000.00
Median
$1,380.38
Typical High
$2,454.71
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,258.93
Median
$2,290.87
Typical High
$3,548.13
Quartz
Setting
Facility
Modifier
Global
Typical Low
$1,819.70
Median
$16,982.44
Typical High
$16,982.44
Quartz
Setting
Professional
Modifier
Global
Typical Low
$1,122.02
Median
$5,248.07
Typical High
$12,022.64
Security Health
Setting
Professional
Modifier
Global
Typical Low
$3,890.45
Median
$3,890.45
Typical High
$3,890.45
Security Health
Setting
Professional
Modifier
Global
Typical Low
$3,162.28
Median
$3,981.07
Typical High
$5,370.32
United
Setting
Facility
Modifier
Global
Typical Low
$5,128.61
Median
$12,022.64
Typical High
$15,848.93
United
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,548.82
Typical High
$4,365.16