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Biopsy Of The Roof Of The Mouth

Connecticut 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?

$158

Typical negotiated rate. In Connecticut, July 2026.

Insurers have agreed to pay about $158 for this service. The price depends on where it is billed: about $155 from a physician practice, and about $4,677 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 6 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$155$123 to $229
FacilityA hospital or hospital-owned outpatient department$4,677$3,715 to $6,310

How much rates vary

Facilitymedian $4,677 · 10th to 90th $2,291 to $8,511Professionalmedian $155 · 10th to 90th $105 to $355
$100$200$500$1K$2K$5K$10Kfacility $4,677professional $155

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
$2,290.87
Median
$4,677.35
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$323.59
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,715.35
Median
$4,365.16
Typical High
$10,964.78
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$245.47
Typical High
$371.54
Cigna
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$234.42
Typical High
$758.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$204.17
Typical High
$398.11
ConnectiCare
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$245.47
Typical High
$309.03
Health New England
Setting
Professional
Modifier
Global
Typical Low
$269.15
Median
$275.42
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$1,096.48
Median
$5,495.41
Typical High
$9,332.54
United
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$199.53
Typical High
$407.38

Where Connecticut 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.

Connecticut· 22nd of 51

$158

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.