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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.

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

$174

Typical negotiated rate. In New York, July 2026.

Insurers have agreed to pay about $174 for this service. The price depends on where it is billed: about $166 from a physician practice, and about $3,467 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 10 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$166$135 to $229
FacilityA hospital or hospital-owned outpatient department$3,467$1,514 to $5,623

How much rates vary

Facilitymedian $3,467 · 10th to 90th $158 to $8,318Professionalmedian $166 · 10th to 90th $110 to $398
$100$200$500$1K$2K$5K$10Kfacility $3,467professional $166

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
$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

Where New York 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 York· 13th of 51

$174

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.