go back

Biopsy Of The Roof Of The Mouth

South Carolina 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?

$148

Typical negotiated rate. In South Carolina, July 2026.

Insurers have agreed to pay about $148 for this service. The price depends on where it is billed: about $145 from a physician practice, and about $219 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$145$123 to $174
FacilityA hospital or hospital-owned outpatient department$219$155 to $2,570

How much rates vary

Facilitymedian $219 · 10th to 90th $129 to $7,943Professionalmedian $145 · 10th to 90th $105 to $263
$100$500$2K$10Kfacility $219professional $145

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
$128.82
Median
$5,623.41
Typical High
$21,877.62
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$144.54
Typical High
$269.15
BCBS
Setting
Facility
Modifier
Global
Typical Low
$1,023.29
Median
$2,238.72
Typical High
$3,388.44
BCBS
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$141.25
Typical High
$199.53
Cigna
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$120.23
Typical High
$426.58
Cigna
Setting
Professional
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$346.74
Medcost
Setting
Professional
Modifier
Global
Typical Low
$194.98
Median
$208.93
Typical High
$213.80
Medcost
Setting
Facility
Modifier
Global
Typical Low
$117.49
Median
$169.82
Typical High
$281.84
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$32.36
Typical High
$33.11
United
Setting
Facility
Modifier
Global
Typical Low
$1,148.15
Median
$5,888.44
Typical High
$9,772.37
United
Setting
Professional
Modifier
Global
Typical Low
$97.72
Median
$144.54
Typical High
$251.19

Where South Carolina 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.

South Carolina· 37th of 51

$148

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.