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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.

Facilitymedian $174 · 10th–90th $110$1,5490%10%10th90th$174Professionalmedian $182 · 10th–90th $112$4170%5%10%10th90th$182$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
$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