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Biopsy Of The Roof Of The Mouth

Iowa 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?

$186

Typical negotiated rate. In Iowa, July 2026.

Insurers have agreed to pay about $186 for this service. The price depends on where it is billed: about $186 from a physician practice, and about $2,239 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$186$135 to $282
FacilityA hospital or hospital-owned outpatient department$2,239$245 to $3,802

How much rates vary

Facilitymedian $2,239 · 10th to 90th $158 to $6,457Professionalmedian $186 · 10th to 90th $105 to $708
$50$200$1K$5Kfacility $2,239professional $186

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
$245.47
Median
$3,388.44
Typical High
$7,943.28
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$165.96
Typical High
$707.95
Cigna
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$275.42
Typical High
$436.52
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$213.80
Typical High
$446.68
Medica
Setting
Facility
Modifier
Global
Typical Low
$128.82
Median
$245.47
Typical High
$3,630.78
Medica
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$295.12
Typical High
$1,096.48
Midlands
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$288.40
Typical High
$398.11
Midlands
Setting
Facility
Modifier
Global
Typical Low
$239.88
Median
$239.88
Typical High
$239.88
Midlands
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$295.12
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$794.33
Median
$3,548.13
Typical High
$5,128.61
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$186.21
Typical High
$354.81
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$251.19
Typical High
$371.54

Where Iowa 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.

Iowa· 6th of 51

$186

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.