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Biopsy Of The Roof Of The Mouth

Florida 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?

$145

Typical negotiated rate. In Florida, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $138 from a physician practice, and about $3,631 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 8 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 $174
FacilityA hospital or hospital-owned outpatient department$3,631$1,445 to $7,244

How much rates vary

Facilitymedian $3,631 · 10th to 90th $457 to $10,715Professionalmedian $138 · 10th to 90th $100 to $245
$1$10$100$1K$10Kfacility $3,631professional $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
$380.19
Median
$3,235.94
Typical High
$10,964.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$141.25
Typical High
$245.47
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$144.54
Typical High
$177.83
AvMed
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$2,818.38
Typical High
$11,220.18
AvMed
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$125.89
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$173.78
Typical High
$1,659.59
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$165.96
Typical High
$309.03
Florida Blue
Setting
Facility
Modifier
Global
Typical Low
$2,570.40
Median
$4,786.30
Typical High
$9,549.93
Florida Blue
Setting
Professional
Modifier
Global
Typical Low
$70.79
Median
$125.89
Typical High
$177.83
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$85.11
Typical High
$177.83
United
Setting
Facility
Modifier
Global
Typical Low
$549.54
Median
$3,090.30
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$89.13
Median
$134.90
Typical High
$245.47
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$112.20
Typical High
$154.88

Where Florida 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.

Florida· 44th of 51

$145

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.