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Biopsy Of The Roof Of The Mouth

Colorado rates for HCPCS 42100

Takes a small piece of tissue from the roof of the mouth or from the uvula, the flap hanging at the back of the throat, so it can be examined under a microscope. Only a sample is taken and the rest of the area is left in place. It is done to find out what is behind a patch, sore, swelling or growth that has not settled on its own.

Rates data updated July 2026.

How much does Biopsy Of The Roof Of The Mouth cost?

$155

Typical negotiated rate. In Colorado, July 2026.

Insurers have agreed to pay about $155 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $3,236 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 7 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$148$117 to $182
FacilityA hospital or hospital-owned outpatient department$3,236$182 to $5,888

How much rates vary

Facilitymedian $3,236 · 10th to 90th $135 to $8,128Professionalmedian $148 · 10th to 90th $107 to $245
$100$200$500$1K$2K$5K$10Kfacility $3,236professional $148

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
$151.36
Median
$3,981.07
Typical High
$7,585.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$144.54
Typical High
$223.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$6,760.83
Typical High
$10,964.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$275.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$602.56
Median
$891.25
Typical High
$1,659.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$173.78
Typical High
$275.42
Denver HMP
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$269.15
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$158.49
Typical High
$457.09
Select Health
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$208.93
Typical High
$323.59
Select Health
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$123.03
Typical High
$165.96
United
Setting
Facility
Modifier
Global
Typical Low
$1,174.90
Median
$3,235.94
Typical High
$6,309.57
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$173.78
Typical High
$281.84

Where Colorado sits

The same service costs 2.1 times more in Minnesota than in Hawaii. 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.

Colorado· 25th of 51

$155

MN $282HI $135

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.