go back

Repair Of The Front Of The Roof Of The Mouth

Delaware rates for HCPCS 42235

Closes a gap in the front part of the roof of the mouth, bringing in a flap of tissue from the partition inside the nose along with the neighbouring palate tissue to cover the opening. Closing it separates the mouth from the nasal cavity so that food and liquid stay where they belong and speech can develop normally. It is part of the surgical care of a cleft of the palate.

Rates data updated July 2026.

How much does Repair Of The Front Of The Roof Of The Mouth cost?

$794

Typical negotiated rate. In Delaware, July 2026.

Insurers have agreed to pay about $794 for this service. The price depends on where it is billed: about $794 from a physician practice, and about $3,311 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 3 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$794$724 to $891
FacilityA hospital or hospital-owned outpatient department$3,311$1,995 to $6,607

How much rates vary

Facilitymedian $3,311 · 10th to 90th $1,660 to $7,244Professionalmedian $794 · 10th to 90th $692 to $1,148
$1K$2K$5Kfacility $3,311professional $794

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$6,606.93
Median
$6,606.93
Typical High
$7,244.36
Aetna
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$794.33
Typical High
$1,148.15
Cigna
Setting
Facility
Modifier
Global
Typical Low
$3,235.94
Median
$3,235.94
Typical High
$3,311.31
Cigna
Setting
Professional
Modifier
Global
Typical Low
$575.44
Median
$891.25
Typical High
$1,380.38
United
Setting
Facility
Modifier
Global
Typical Low
$776.25
Median
$1,659.59
Typical High
$2,511.89
United
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$776.25
Typical High
$1,258.93

Where Delaware sits

The same service costs 3.0 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.

Delaware· 47th of 51

$794

CA $2,188WV $724

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.