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Biopsy Of The Roof Of The Mouth

South Dakota 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?

$162

Typical negotiated rate. In South Dakota, July 2026.

Insurers have agreed to pay about $162 for this service. The price depends on where it is billed: about $155 from a physician practice, and about $204 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$155$141 to $245
FacilityA hospital or hospital-owned outpatient department$204$138 to $331

How much rates vary

Facilitymedian $204 · 10th to 90th $107 to $2,291Professionalmedian $155 · 10th to 90th $105 to $331
$50$100$200$500$1K$2Kfacility $204professional $155

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
$107.15
Median
$2,290.87
Typical High
$4,365.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$141.25
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$331.13
Typical High
$436.52
Medica
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$190.55
Typical High
$389.05
Medica
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$257.04
Typical High
$1,096.48
Midlands
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$275.42
Typical High
$338.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$302.00
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$218.78
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$3,162.28
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$208.93
Typical High
$338.84
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$257.04
Typical High
$380.19

Where South Dakota 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.

South Dakota· 18th of 51

$162

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.