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Biopsy Of The Roof Of The Mouth

Pennsylvania 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 $2,344 · 10th–90th $158$7,7620%5%10th90th$2,344Professionalmedian $145 · 10th–90th $105$2630%20%10th90th$145$10.0$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
$158.49
Median
$2,398.83
Typical High
$8,317.64
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$144.54
Typical High
$263.03
Ambetter
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$144.54
Typical High
$144.54
Capital Blue Cross
Setting
Facility
Modifier
Global
Typical Low
$2,630.27
Median
$2,691.53
Typical High
$57,543.99
Capital Blue Cross
Setting
Professional
Modifier
Global
Typical Low
$141.25
Median
$141.25
Typical High
$154.88
Cigna
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$245.47
Typical High
$645.65
Cigna
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$162.18
Typical High
$281.84
Emblem Health
Setting
Facility
Modifier
Global
Typical Low
$229.09
Median
$229.09
Typical High
$229.09
Emblem Health
Setting
Professional
Modifier
Global
Typical Low
$177.83
Median
$213.80
Typical High
$309.03
Geisinger
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$144.54
Typical High
$169.82
Geisinger
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$154.88
Typical High
$251.19
Highmark BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,479.11
Median
$3,388.44
Typical High
$7,244.36
Martin's Point
Setting
Facility
Modifier
Global
Typical Low
$478.63
Median
$2,344.23
Typical High
$8,317.64
Martin's Point
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$151.36
Typical High
$467.74
Oscar Health
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$162.18
Typical High
$363.08
UPMC Health Plan
Setting
Facility
Modifier
Global
Typical Low
$151.36
Median
$281.84
Typical High
$512.86
UPMC Health Plan
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$138.04
Typical High
$151.36
United
Setting
Facility
Modifier
Global
Typical Low
$575.44
Median
$2,344.23
Typical High
$5,248.07
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$144.54
Typical High
$239.88