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Biopsy Of The Roof Of The Mouth

Maine 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?

$178

Typical negotiated rate. In Maine, July 2026.

Insurers have agreed to pay about $178 for this service. The price depends on where it is billed: about $178 from a physician practice, and about $871 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$178$132 to $229
FacilityA hospital or hospital-owned outpatient department$871$457 to $3,162

How much rates vary

Facilitymedian $871 · 10th to 90th $457 to $3,162Professionalmedian $178 · 10th to 90th $117 to $339
$100$200$500$1K$2Kfacility $871professional $178

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. Small sample; interpret with caution. Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$870.96
Median
$870.96
Typical High
$870.96
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$141.25
Typical High
$177.83
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$177.83
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$457.09
Median
$457.09
Typical High
$457.09
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$190.55
Typical High
$354.81
Harvard Pilgrim
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$218.78
Typical High
$398.11
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$151.36
Typical High
$213.80
United
Setting
Facility
Modifier
Global
Typical Low
$3,162.28
Median
$3,162.28
Typical High
$3,162.28
United
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$186.21
Typical High
$338.84

Where Maine 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.

Maine· 9th of 51

$178

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.