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Biopsy Of The Roof Of The Mouth

Massachusetts 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 Massachusetts, 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 $1,000 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 9 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$129 to $269
FacilityA hospital or hospital-owned outpatient department$1,000$158 to $2,570

How much rates vary

Facilitymedian $1,000 · 10th to 90th $132 to $3,715Professionalmedian $166 · 10th to 90th $107 to $398
$100$200$500$1K$2K$5Kfacility $1,000professional $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
$158.49
Median
$2,187.76
Typical High
$3,715.35
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$371.54
AllWays Health Partners
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$1,258.93
Typical High
$4,677.35
AllWays Health Partners
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$194.98
Typical High
$1,047.13
BCBS
Setting
Facility
Modifier
Global
Typical Low
$131.83
Median
$131.83
Typical High
$302.00
BCBS
Setting
Professional
Modifier
Global
Typical Low
$229.09
Median
$302.00
Typical High
$954.99
Cigna
Setting
Facility
Modifier
Global
Typical Low
$162.18
Median
$446.68
Typical High
$501.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$204.17
Typical High
$426.58
Fallon Health
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$147.91
Typical High
$3,311.31
Fallon Health
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$204.17
Typical High
$316.23
Harvard Pilgrim
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$3,162.28
Typical High
$8,511.38
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$204.17
Typical High
$380.19
Health New England
Setting
Facility
Modifier
Global
Typical Low
$0.85
Median
$0.85
Typical High
$2,454.71
Health New England
Setting
Professional
Modifier
Global
Typical Low
$275.42
Median
$275.42
Typical High
$275.42
Mass General Brigham
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$1,258.93
Typical High
$4,677.35
Mass General Brigham
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$194.98
Typical High
$1,047.13
United
Setting
Facility
Modifier
Global
Typical Low
$616.60
Median
$2,818.38
Typical High
$6,918.31
United
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$213.80
Typical High
$398.11

Where Massachusetts 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.

Massachusetts· 15th 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.