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Biopsy Of The Roof Of The Mouth

Maryland 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 Maryland, July 2026.

Insurers have agreed to pay about $145 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $447 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$145$117 to $178
FacilityA hospital or hospital-owned outpatient department$447$162 to $776

How much rates vary

Facilitymedian $447 · 10th to 90th $98 to $1,479Professionalmedian $145 · 10th to 90th $102 to $324
$100$200$500$1K$2Kfacility $447professional $145

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
$77.62
Median
$77.62
Typical High
$3,311.31
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$144.54
Typical High
$371.54
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$114.82
Typical High
$165.96
Cigna
Setting
Facility
Modifier
Global
Typical Low
$87.10
Median
$100.00
Typical High
$436.52
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$162.18
Typical High
$302.00
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$169.82
Typical High
$239.88
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$478.63
Typical High
$1,318.26
United
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$151.36
Typical High
$269.15
Wellpoint
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$158.49
Typical High
$229.09

Where Maryland 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.

Maryland· 46th 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.