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Biopsy Of The Roof Of The Mouth

Georgia 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?

$174

Typical negotiated rate. In Georgia, July 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $2,884 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$166$132 to $224
FacilityA hospital or hospital-owned outpatient department$2,884$1,202 to $4,571

How much rates vary

Facilitymedian $2,884 · 10th to 90th $513 to $6,918Professionalmedian $166 · 10th to 90th $110 to $316
$100$200$500$1K$2K$5K$10Kfacility $2,884professional $166

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
$173.78
Median
$3,548.13
Typical High
$7,585.78
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$154.88
Typical High
$316.23
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$128.82
Typical High
$144.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$691.83
Median
$2,570.40
Typical High
$5,888.44
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$208.93
Typical High
$316.23
CareSource
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Cigna
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$144.54
Typical High
$537.03
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$181.97
Typical High
$338.84
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$177.83
Typical High
$309.03
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$162.18
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$512.86
Median
$2,137.96
Typical High
$5,011.87
United
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$158.49
Typical High
$288.40

Where Georgia 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.

Georgia· 14th of 51

$174

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.