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Biopsy Of The Roof Of The Mouth

Idaho 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?

$170

Typical negotiated rate. In Idaho, July 2026.

Insurers have agreed to pay about $170 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $224 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 8 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$166$135 to $234
FacilityA hospital or hospital-owned outpatient department$224$158 to $457

How much rates vary

Facilitymedian $224 · 10th to 90th $129 to $3,715Professionalmedian $166 · 10th to 90th $110 to $295
$100$200$500$1K$2K$5Kfacility $224professional $166

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
$1,412.54
Median
$4,466.84
Typical High
$7,079.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$151.36
Typical High
$316.23
BCBS
Setting
Facility
Modifier
Global
Typical Low
$181.97
Median
$1,513.56
Typical High
$3,981.07
BCBS
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$223.87
Typical High
$288.40
Cigna
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$186.21
Typical High
$281.84
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$186.21
Typical High
$354.81
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$218.78
Typical High
$302.00
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$138.04
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$3,467.37
Typical High
$5,011.87
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$181.97
Median
$234.42
Typical High
$295.12
Select Health
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$977.24
Typical High
$2,344.23
Select Health
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$138.04
Typical High
$208.93
United
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$6,165.95
Typical High
$7,762.47
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$177.83
Typical High
$275.42

Where Idaho 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.

Idaho· 16th of 51

$170

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.