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Biopsy Of The Roof Of The Mouth

Montana 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?

$151

Typical negotiated rate. In Montana, July 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $204 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$148$110 to $191
FacilityA hospital or hospital-owned outpatient department$204$186 to $257

How much rates vary

Facilitymedian $204 · 10th to 90th $145 to $309Professionalmedian $148 · 10th to 90th $102 to $257
$100$1K$10Kfacility $204professional $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
Professional
Modifier
Global
Typical Low
$100.00
Median
$138.04
Typical High
$208.93
BCBS
Setting
Facility
Modifier
Global
Typical Low
$64,565.42
Median
$75,857.76
Typical High
$91,201.08
BCBS
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$181.97
Typical High
$446.68
MountainHealth Co-op
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$251.19
Typical High
$275.42
MountainHealth Co-op
Setting
Professional
Modifier
Global
Typical Low
$190.55
Median
$251.19
Typical High
$275.42
Providence
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$186.21
Typical High
$323.59
Providence
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$223.87
Typical High
$371.54
United
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$190.55
Typical High
$3,162.28
United
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$204.17
Typical High
$281.84

Where Montana 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.

Montana· 32nd of 51

$151

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.