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Repair Of The Front Of The Roof Of The Mouth

New Jersey 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?

$851

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $851 for this service. The price depends on where it is billed: about $832 from a physician practice, and about $8,511 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 5 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$832$692 to $1,148
FacilityA hospital or hospital-owned outpatient department$8,511$6,026 to $11,482

How much rates vary

Facilitymedian $8,511 · 10th to 90th $4,365 to $13,490Professionalmedian $832 · 10th to 90th $631 to $2,089
$500$1K$2K$5K$10K$20Kfacility $8,511professional $832

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
$4,365.16
Median
$8,511.38
Typical High
$13,489.63
Aetna
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$776.25
Typical High
$5,888.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$549.54
Median
$933.25
Typical High
$1,819.70
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$724.44
Median
$977.24
Typical High
$1,445.44
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$12,882.50
Median
$19,054.61
Typical High
$30,199.52
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$831.76
Typical High
$1,819.70
United
Setting
Facility
Modifier
Global
Typical Low
$3,388.44
Median
$8,709.64
Typical High
$18,197.01
United
Setting
Professional
Modifier
Global
Typical Low
$501.19
Median
$831.76
Typical High
$1,621.81

Where New Jersey 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.

New Jersey· 36th of 51

$851

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.