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Biopsy Of The Roof Of The Mouth

Nebraska 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 Nebraska, July 2026.

Insurers have agreed to pay about $178 for this service. The price depends on where it is billed: about $158 from a physician practice, and about $3,388 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$158$129 to $245
FacilityA hospital or hospital-owned outpatient department$3,388$240 to $7,586

How much rates vary

Facilitymedian $3,388 · 10th to 90th $155 to $13,490Professionalmedian $158 · 10th to 90th $102 to $355
$50$200$1K$5K$20Kfacility $3,388professional $158

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
$2,187.76
Median
$4,365.16
Typical High
$14,454.40
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$154.88
Typical High
$354.81
BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,548.13
Median
$4,677.35
Typical High
$9,120.11
BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$190.55
Typical High
$269.15
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$275.42
Typical High
$478.63
Medica
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$177.83
Typical High
$338.84
Medica
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$316.23
Typical High
$1,096.48
Midlands
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$338.84
Typical High
$436.52
Midlands
Setting
Professional
Modifier
Global
Typical Low
$208.93
Median
$275.42
Typical High
$346.74
United
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$2,344.23
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$218.78
Typical High
$354.81

Where Nebraska 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.

Nebraska· 12th 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.