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Biopsy Of The Roof Of The Mouth

Tennessee 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 Tennessee, July 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $2,042 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$148$120 to $191
FacilityA hospital or hospital-owned outpatient department$2,042$955 to $2,630

How much rates vary

Facilitymedian $2,042 · 10th to 90th $372 to $3,981Professionalmedian $148 · 10th to 90th $107 to $269
$100$200$500$1K$2K$5Kfacility $2,042professional $148

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
$316.23
Median
$1,778.28
Typical High
$4,073.80
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$147.91
Typical High
$263.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$141.25
BCBS
Setting
Facility
Modifier
Global
Typical Low
$977.24
Median
$2,137.96
Typical High
$2,951.21
BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$190.55
Typical High
$309.03
Cigna
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$501.19
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$162.18
Typical High
$275.42
Lucent Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$3,890.45
Typical High
$3,890.45
Lucent Health
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,230.27
Typical High
$1,230.27
United
Setting
Facility
Modifier
Global
Typical Low
$912.01
Median
$2,089.30
Typical High
$3,715.35
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$263.03

Where Tennessee 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.

Tennessee· 33rd 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.