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Mouth Impression For A Palate Plate

Texas rates for HCPCS 42280

A mold is taken of the upper jaw and the roof of the mouth so that a custom plate can be made to fit it exactly. Soft material is pressed against the palate and upper gums, then set and lifted out to give an accurate copy of the shape. It is the preparation step before the finished plate is made and fitted.

Rates data updated July 2026.

Facilitymedian $331 · 10th–90th $117$4,1690%5%10th90th$331Professionalmedian $166 · 10th–90th $107$2630%10%10th90th$166$50.0$200.0$1.0K$5.0K

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
$426.58
Median
$2,238.72
Typical High
$6,918.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$165.96
Typical High
$257.04
BCBS
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$165.96
Typical High
$275.42
Christus
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$97.72
Typical High
$177.83
Cigna
Setting
Facility
Modifier
Global
Typical Low
$50.12
Median
$138.04
Typical High
$181.97
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$186.21
Typical High
$323.59
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$56.23
Typical High
$1,288.25
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,288.25
Median
$1,479.11
Typical High
$1,479.11
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$181.97
Typical High
$323.59
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$218.78
Typical High
$346.74
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$147.91
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$151.36
Providence
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$181.97
Typical High
$323.59
Providence
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$154.88
Median
$812.83
Typical High
$2,290.87
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$154.88
Typical High
$251.19
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$177.83
Typical High
$251.19