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Repair Of The Front Of The Roof Of The Mouth

Ohio 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.

Facilitymedian $6,026 · 10th–90th $1,202$12,5890%10%10th90th$6,026Professionalmedian $794 · 10th–90th $646$1,3800%20%40%10th90th$794$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$1,202.26
Median
$8,912.51
Typical High
$12,589.25
Aetna
Setting
Professional
Modifier
Global
Typical Low
$676.08
Median
$794.33
Typical High
$2,089.30
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$645.65
Typical High
$645.65
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,412.54
Median
$3,715.35
Typical High
$16,982.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$645.65
Median
$812.83
Typical High
$1,318.26
CareSource
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$776.25
Typical High
$3,630.78
CareSource
Setting
Professional
Modifier
Global
Typical Low
$758.58
Median
$758.58
Typical High
$870.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$1,174.90
Typical High
$4,897.79
Cigna
Setting
Professional
Modifier
Global
Typical Low
$537.03
Median
$933.25
Typical High
$1,584.89
Medical Mutual of Ohio
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$1,230.27
Typical High
$4,897.79
Medical Mutual of Ohio
Setting
Professional
Modifier
Global
Typical Low
$446.68
Median
$933.25
Typical High
$1,479.11
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$33.11
SummaCare
Setting
Facility
Modifier
Global
Typical Low
$9,120.11
Median
$9,120.11
Typical High
$9,120.11
SummaCare
Setting
Professional
Modifier
Global
Typical Low
$691.83
Median
$812.83
Typical High
$1,513.56
United
Setting
Facility
Modifier
Global
Typical Low
$1,047.13
Median
$5,754.40
Typical High
$11,748.98
United
Setting
Professional
Modifier
Global
Typical Low
$588.84
Median
$812.83
Typical High
$1,380.38