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Repair Of The Front Of The Roof Of The Mouth

Maine 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?

$912

Typical negotiated rate. In Maine, 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 $7,762 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 6 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$851 to $1,413
FacilityA hospital or hospital-owned outpatient department$7,762$977 to $12,023

How much rates vary

Facilitymedian $7,762 · 10th to 90th $977 to $12,023Professionalmedian $912 · 10th to 90th $759 to $1,820
$500.0$1.0K$2.0K$5.0K$10.0K$20.0Kfacility $7,762professional $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. 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
$7,762.47
Median
$7,762.47
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$851.14
Typical High
$891.25
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$1,148.15
Typical High
$1,778.28
Cigna
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$977.24
Typical High
$977.24
Cigna
Setting
Professional
Modifier
Global
Typical Low
$602.56
Median
$977.24
Typical High
$1,778.28
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$831.76
Median
$1,122.02
Typical High
$1,995.26
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$870.96
Typical High
$1,445.44
United
Setting
Facility
Modifier
Global
Typical Low
$12,022.64
Median
$12,022.64
Typical High
$12,022.64
United
Setting
Professional
Modifier
Global
Typical Low
$741.31
Median
$1,071.52
Typical High
$1,949.84

Where Maine sits

The same service costs 3.0 times more in California than in West Virginia. Every bar is a state, most expensive first. Pick one to see its carriers and full range.

Maine $912 · 28th of 51
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.