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Biopsy Of The Roof Of The Mouth

Utah 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 Utah, July 2026.

Insurers have agreed to pay about $155 for this service. The price depends on where it is billed: about $151 from a physician practice, and about $3,162 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$151$117 to $214
FacilityA hospital or hospital-owned outpatient department$3,162$2,239 to $4,467

How much rates vary

Facilitymedian $3,162 · 10th to 90th $195 to $4,571Professionalmedian $151 · 10th to 90th $100 to $427
$50$100$200$500$1K$2K$5Kfacility $3,162professional $151

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
$144.54
Median
$3,162.28
Typical High
$4,570.88
Aetna
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$151.36
Typical High
$426.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$177.83
Typical High
$316.23
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$346.74
Regence BlueShield
Setting
Facility
Modifier
Global
Typical Low
$2,137.96
Median
$2,951.21
Typical High
$4,466.84
Regence BlueShield
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$208.93
Typical High
$288.40
Select Health
Setting
Facility
Modifier
Global
Typical Low
$295.12
Median
$295.12
Typical High
$295.12
Select Health
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$199.53
Typical High
$295.12
U of Utah Health Plan
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$190.55
Typical High
$275.42
United
Setting
Facility
Modifier
Global
Typical Low
$125.89
Median
$3,162.28
Typical High
$5,128.61
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$239.88

Where Utah 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.

Utah· 23rd 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.