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Biopsy Of The Roof Of The Mouth

Illinois 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.

Facilitymedian $1,288 · 10th–90th $148$5,3700%5%10th90th$1,288Professionalmedian $155 · 10th–90th $107$2690%10%10th90th$155$20.0$100.0$500.0$2.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$147.91
Median
$1,230.27
Typical High
$5,623.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$269.15
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$194.98
Median
$1,995.26
Typical High
$2,691.53
BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$229.09
Cigna
Setting
Facility
Modifier
Global
Typical Low
$158.49
Median
$177.83
Typical High
$1,000.00
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$177.83
Typical High
$323.59
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$134.90
Median
$223.87
Typical High
$562.34
Hally Health
Setting
Facility
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$100.00
Hally Health
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$138.04
Typical High
$194.98
Molina
Setting
Professional
Modifier
Global
Typical Low
$23.44
Median
$33.11
Typical High
$199.53
United
Setting
Facility
Modifier
Global
Typical Low
$831.76
Median
$2,089.30
Typical High
$4,365.16
United
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$162.18
Typical High
$275.42