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Biopsy Of The Roof Of The Mouth

Kentucky 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?

$138

Typical negotiated rate. In Kentucky, July 2026.

Insurers have agreed to pay about $138 for this service. The price depends on where it is billed: about $138 from a physician practice, and about $1,778 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$138$110 to $174
FacilityA hospital or hospital-owned outpatient department$1,778$174 to $5,012

How much rates vary

Facilitymedian $1,778 · 10th to 90th $135 to $10,715Professionalmedian $138 · 10th to 90th $100 to $245
$50$200$1K$5Kfacility $1,778professional $138

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
$134.90
Median
$851.14
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$138.04
Typical High
$269.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$10,715.19
Typical High
$11,220.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$138.04
Typical High
$181.97
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$114.82
Typical High
$162.18
CareSource
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$120.23
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$173.78
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$169.82
Typical High
$870.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$60.26
United
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$1,445.44
Typical High
$4,168.69
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$239.88

Where Kentucky 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.

Kentucky· 49th of 51

$138

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.