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Major Revision of a Cleft Palate Repair

Rhode Island rates for HCPCS 42215

This surgery substantially revises an earlier cleft palate repair when the initial reconstruction did not achieve a good result, such as a persistent opening, poor healing, or ongoing speech and feeding problems. The surgeon reopens and reworks the previously repaired tissue to improve the shape, closure, and function of the palate. It is a more involved procedure than the original repair because it must work around scarred tissue from the prior surgery.

Rates data updated July 2026.

How much does Major Revision of a Cleft Palate Repair cost?

$912

Typical negotiated rate. In Rhode Island, July 2026.

Insurers have agreed to pay about $912 for this service. The price depends on where it is billed: about $912 from a physician practice, and about $5,495 from a hospital or other facility. The two figures are alternatives, not parts of one bill.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 4 insurance carriers under federal price transparency rules.

Where it's billed changes the price

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$912$759 to $912
FacilityA hospital or hospital-owned outpatient department$5,495$3,631 to $8,710

How much rates vary

Facilitymedian $5,495 · 10th to 90th $1,318 to $13,183Professionalmedian $912 · 10th to 90th $646 to $1,096
$1K$2K$5K$10Kfacility $5,495professional $912

Distribution of negotiated rates across all payers (price axis is log-scale). Each curve is scaled to its own total: facility and professional rates are different services, shown together to compare where they cluster. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$3,981.07
Typical High
$5,495.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$912.01
Typical High
$1,000.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$812.83
Median
$954.99
Typical High
$1,412.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$1,318.26
Median
$5,370.32
Typical High
$5,370.32
Cigna
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$1,047.13
Typical High
$1,659.59
United
Setting
Facility
Modifier
Global
Typical Low
$1,288.25
Median
$7,244.36
Typical High
$13,182.57
United
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$831.76
Typical High
$1,513.56

Where Rhode Island sits

The same service costs 3.3 times more in California than in West Virginia. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Rhode Island· 25th of 51

$912

CA $2,291WV $692

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.