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Biopsy Of The Roof Of The Mouth

North Carolina 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?

$182

Typical negotiated rate. In North Carolina, July 2026.

Insurers have agreed to pay about $182 for this service. The price depends on where it is billed: about $182 from a physician practice, and about $174 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$182$141 to $269
FacilityA hospital or hospital-owned outpatient department$174$138 to $288

How much rates vary

Facilitymedian $174 · 10th to 90th $110 to $1,549Professionalmedian $182 · 10th to 90th $112 to $417
$100$200$500$1K$2K$5Kfacility $174professional $182

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
$144.54
Median
$933.25
Typical High
$6,456.54
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$147.91
Typical High
$398.11
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
BCBS
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$131.83
Typical High
$147.91
BCBS
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$229.09
Typical High
$426.58
Cigna
Setting
Facility
Modifier
Global
Typical Low
$95.50
Median
$169.82
Typical High
$758.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$186.21
Typical High
$338.84
Medcost
Setting
Professional
Modifier
Global
Typical Low
$213.80
Median
$213.80
Typical High
$213.80
Medcost
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$158.49
Typical High
$263.03
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$380.19
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$162.18
United
Setting
Facility
Modifier
Global
Typical Low
$398.11
Median
$2,041.74
Typical High
$6,309.57
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$141.25
Typical High
$245.47
Wellcare
Setting
Facility
Modifier
Global
Typical Low
$56.23
Median
$3,890.45
Typical High
$3,890.45
Wellcare
Setting
Professional
Modifier
Global
Typical Low
$1,047.13
Median
$1,047.13
Typical High
$1,230.27

Where North Carolina 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.

North Carolina· 8th of 51

$182

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.