go back

Cleft Palate Repair With Gum Ridge Bone Graft

West 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 $1,122 · 10th–90th $1,072$2,6300%20%40%10th90th$1,122Professionalmedian $1,072 · 10th–90th $977$1,5850%20%10th90th$1,072$500.0$1.0K$2.0K$5.0K$10.0K

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
$1,071.52
Median
$1,071.52
Typical High
$2,630.27
Aetna
Setting
Professional
Modifier
Global
Typical Low
$977.24
Median
$1,071.52
Typical High
$1,380.38
CareSource
Setting
Facility
Modifier
Global
Typical Low
$1,122.02
Median
$1,122.02
Typical High
$1,380.38
CareSource
Setting
Professional
Modifier
Global
Typical Low
$1,230.27
Median
$1,230.27
Typical High
$1,230.27
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,698.24
Median
$1,698.24
Typical High
$1,698.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$891.25
Median
$1,445.44
Typical High
$9,549.93
United
Setting
Facility
Modifier
Global
Typical Low
$1,348.96
Median
$3,548.13
Typical High
$16,595.87
United
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$1,148.15
Typical High
$1,819.70