go back

Biopsy Of The Roof Of The Mouth

Indiana 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?

$148

Typical negotiated rate. In Indiana, July 2026.

Insurers have agreed to pay about $148 for this service. The price depends on where it is billed: about $141 from a physician practice, and about $6,607 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$141$112 to $178
FacilityA hospital or hospital-owned outpatient department$6,607$4,266 to $8,913

How much rates vary

Facilitymedian $6,607 · 10th to 90th $240 to $10,471Professionalmedian $141 · 10th to 90th $105 to $229
$100$200$500$1K$2K$5K$10Kfacility $6,607professional $141

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
$120.23
Median
$1,380.38
Typical High
$5,623.41
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$141.25
Typical High
$213.80
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$4,265.80
Median
$8,317.64
Typical High
$11,220.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$281.84
CareSource
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$112.20
Typical High
$125.89
CareSource
Setting
Professional
Modifier
Global
Typical Low
$93.33
Median
$93.33
Typical High
$93.33
Cigna
Setting
Facility
Modifier
Global
Typical Low
$123.03
Median
$173.78
Typical High
$758.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$288.40
United
Setting
Facility
Modifier
Global
Typical Low
$630.96
Median
$3,467.37
Typical High
$6,456.54
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$141.25
Typical High
$229.09

Where Indiana 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.

Indiana· 42nd of 51

$148

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.