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Biopsy Of The Roof Of The Mouth

New Jersey 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 $5,495 · 10th–90th $263$10,4710%10%10th90th$5,495Professionalmedian $148 · 10th–90th $100$3240%10%10th90th$148$100.0$500.0$2.0K$10.0K

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
$263.03
Median
$5,495.41
Typical High
$10,715.19
Aetna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$138.04
Typical High
$288.40
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Cigna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$173.78
Typical High
$389.05
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$158.49
Median
$213.80
Typical High
$309.03
Horizon BCBS
Setting
Facility
Modifier
Global
Typical Low
$251.19
Median
$4,786.30
Typical High
$6,918.31
Horizon BCBS
Setting
Professional
Modifier
Global
Typical Low
$87.10
Median
$158.49
Typical High
$323.59
United
Setting
Facility
Modifier
Global
Typical Low
$1,778.28
Median
$4,897.79
Typical High
$8,511.38
United
Setting
Professional
Modifier
Global
Typical Low
$85.11
Median
$144.54
Typical High
$295.12