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Biopsy Of The Roof Of The Mouth

Rhode Island 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?

$151

Typical negotiated rate. In Rhode Island, July 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $151 from a physician practice, and about $2,399 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 4 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$135 to $191
FacilityA hospital or hospital-owned outpatient department$2,399$1,549 to $4,074

How much rates vary

Facilitymedian $2,399 · 10th to 90th $525 to $5,012Professionalmedian $151 · 10th to 90th $112 to $214
$100$200$500$1K$2K$5Kfacility $2,399professional $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
$1,513.56
Median
$1,548.82
Typical High
$3,981.07
Aetna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$141.25
Typical High
$190.55
BCBS
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$165.96
Typical High
$281.84
Cigna
Setting
Facility
Modifier
Global
Typical Low
$169.82
Median
$169.82
Typical High
$446.68
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$363.08
United
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$3,467.37
Typical High
$5,495.41
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$154.88
Typical High
$251.19

Where Rhode Island 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.

Rhode Island· 31st of 51

$151

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.