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Removal of Part of the Roof of the Mouth

Washington rates for HCPCS 42120

Removes a section of the palate, the roof of the mouth, or takes out a large growth located there along with surrounding tissue. It is done for tumors and for other damaged or diseased tissue that cannot be treated by lesser means. The resulting gap may be reconstructed, or fitted with a plate that seals the mouth from the nasal cavity.

Rates data updated July 2026.

How much does Removal of Part of the Roof of the Mouth cost?

$2,570

Typical facility fee. In Washington, July 2026.

Insurers have agreed to pay about $2,570 for this service. Most negotiated rates run $1,738 to $8,710.

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 8 insurance carriers under federal price transparency rules.

How much rates vary

Facilitymedian $2,570 · 10th to 90th $1,259 to $18,197
$1K$2K$5K$10K$20Kfacility $2,570

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
$1,445.44
Median
$6,456.54
Typical High
$18,620.87
Asuris Northwest Health
Setting
Facility
Modifier
Global
Typical Low
$10,715.19
Median
$18,197.01
Typical High
$32,359.37
Cigna
Setting
Facility
Modifier
Global
Typical Low
$891.25
Median
$1,096.48
Typical High
$8,317.64
Kaiser Permanente
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$2,187.76
Typical High
$7,943.28
Pacific Source
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$1,949.84
Typical High
$1,995.26
Premera BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,348.96
Median
$1,380.38
Typical High
$4,168.69
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$10,964.78
Median
$17,378.01
Typical High
$31,622.78
United
Setting
Facility
Modifier
Global
Typical Low
$1,548.82
Median
$16,982.44
Typical High
$33,113.11

Where Washington sits

The same service costs 14.5 times more in Indiana 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.

Washington· 35th of 50

$2,570

IN $14,125WV $977

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.