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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.

How much does Biopsy Of The Roof Of The Mouth cost?

$151

Typical negotiated rate. In New Jersey, July 2026.

Insurers have agreed to pay about $151 for this service. The price depends on where it is billed: about $148 from a physician practice, and about $5,495 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$148$115 to $195
FacilityA hospital or hospital-owned outpatient department$5,495$3,548 to $7,079

How much rates vary

Facilitymedian $5,495 · 10th to 90th $263 to $10,471Professionalmedian $148 · 10th to 90th $100 to $324
$100$200$500$1K$2K$5K$10Kfacility $5,495professional $148

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
$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

Where New Jersey 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.

New Jersey· 27th of 51

$151

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.