go back

Biopsy Of The Roof Of The Mouth

New York 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 $3,467 · 10th–90th $158$8,3180%10%10th90th$3,467Professionalmedian $166 · 10th–90th $110$3980%20%10th90th$166$50.0$200.0$1.0K$5.0K$20.0K

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
$138.04
Median
$2,630.27
Typical High
$7,762.47
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$147.91
Typical High
$295.12
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$48.98
Median
$144.54
Typical High
$144.54
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$4,786.30
Typical High
$9,120.11
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$154.88
Typical High
$288.40
CDPHP
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$4,073.80
CDPHP
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$151.36
Typical High
$208.93
Cigna
Setting
Facility
Modifier
Global
Typical Low
$173.78
Median
$173.78
Typical High
$1,230.27
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$199.53
Typical High
$537.03
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$54.95
Median
$120.23
Typical High
$269.15
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$173.78
Median
$229.09
Typical High
$331.13
Excellus BCBS
Setting
Facility
Modifier
Global
Typical Low
$134.90
Median
$134.90
Typical High
$134.90
Excellus BCBS
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$186.21
Typical High
$309.03
MVP Health Care
Setting
Facility
Modifier
Global
Typical Low
$112.20
Median
$50,118.72
Typical High
$75,857.76
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$251.19
Typical High
$398.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,584.89
Median
$3,467.37
Typical High
$6,760.83
United
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$218.78
Typical High
$512.86
Univera
Setting
Facility
Modifier
Global
Typical Low
$91.20
Median
$131.83
Typical High
$426.58
Univera
Setting
Professional
Modifier
Global
Typical Low
$120.23
Median
$173.78
Typical High
$309.03