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Biopsy Of The Roof Of The Mouth

South Dakota 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 $204 · 10th–90th $107$2,2910%5%10%10th90th$204Professionalmedian $155 · 10th–90th $105$3310%20%10th90th$155$50.0$100.0$200.0$500.0$1.0K$2.0K

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
$107.15
Median
$2,290.87
Typical High
$4,365.16
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$141.25
Typical High
$162.18
Cigna
Setting
Professional
Modifier
Global
Typical Low
$186.21
Median
$331.13
Typical High
$436.52
Medica
Setting
Facility
Modifier
Global
Typical Low
$104.71
Median
$190.55
Typical High
$389.05
Medica
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$257.04
Typical High
$1,096.48
Midlands
Setting
Professional
Modifier
Global
Typical Low
$245.47
Median
$275.42
Typical High
$338.84
Midlands
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$223.87
Typical High
$302.00
Sanford Health Plan
Setting
Professional
Modifier
Global
Typical Low
$154.88
Median
$218.78
Typical High
$281.84
United
Setting
Facility
Modifier
Global
Typical Low
$1,995.26
Median
$1,995.26
Typical High
$3,162.28
United
Setting
Professional
Modifier
Global
Typical Low
$128.82
Median
$208.93
Typical High
$338.84
Wellmark
Setting
Professional
Modifier
Global
Typical Low
$223.87
Median
$257.04
Typical High
$380.19