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Biopsy Of The Roof Of The Mouth

Kentucky 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 $1,778 · 10th–90th $135$10,7150%5%10th90th$1,778Professionalmedian $138 · 10th–90th $100$2450%10%10th90th$138$50.0$200.0$1.0K$5.0K

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
$134.90
Median
$851.14
Typical High
$8,511.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$138.04
Typical High
$269.15
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$5,011.87
Median
$10,715.19
Typical High
$11,220.18
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$138.04
Typical High
$181.97
CareSource
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$114.82
Typical High
$162.18
CareSource
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$120.23
Typical High
$162.18
Cigna
Setting
Facility
Modifier
Global
Typical Low
$34.67
Median
$173.78
Typical High
$173.78
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$169.82
Typical High
$870.96
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$60.26
United
Setting
Facility
Modifier
Global
Typical Low
$190.55
Median
$1,445.44
Typical High
$4,168.69
United
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$147.91
Typical High
$239.88