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Biopsy Of The Roof Of The Mouth

Delaware 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?

$138

Typical negotiated rate. In Delaware, July 2026.

Insurers have agreed to pay about $138 for this service. The price depends on where it is billed: about $138 from a physician practice, and about $2,630 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$138$115 to $166
FacilityA hospital or hospital-owned outpatient department$2,630$2,630 to $2,630

How much rates vary

Facilitymedian $2,630 · 10th to 90th $417 to $3,236Professionalmedian $138 · 10th to 90th $102 to $234
$100$200$500$1K$2K$5Kfacility $2,630professional $138

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
$2,630.27
Median
$2,630.27
Typical High
$3,235.94
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$134.90
Typical High
$234.42
Cigna
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$109.65
Typical High
$1,412.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$158.49
Typical High
$263.03
Highmark BCBS
Setting
Professional
Modifier
Global
Typical Low
$147.91
Median
$147.91
Typical High
$147.91
United
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$114.82
Typical High
$1,318.26
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$138.04
Typical High
$218.78

Where Delaware 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.

Delaware· 48th of 51

$138

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.