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Biopsy Of The Roof Of The Mouth

Virginia 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 $191 · 10th–90th $115$5,2480%5%10%10th90th$191Professionalmedian $151 · 10th–90th $107$2510%10%10th90th$151$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

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
$165.96
Median
$2,818.38
Typical High
$7,079.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$107.15
Median
$147.91
Typical High
$223.87
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$3,090.30
Median
$3,981.07
Typical High
$4,466.84
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$165.96
Typical High
$263.03
CareFirst
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$123.03
Typical High
$660.69
Cigna
Setting
Facility
Modifier
Global
Typical Low
$93.33
Median
$104.71
Typical High
$346.74
Cigna
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$165.96
Typical High
$302.00
Kaiser Permanente
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$177.83
Typical High
$363.08
Medcost
Setting
Professional
Modifier
Global
Typical Low
$169.82
Median
$208.93
Typical High
$288.40
Medcost
Setting
Facility
Modifier
Global
Typical Low
$114.82
Median
$169.82
Typical High
$275.42
Medcost
Setting
Professional
Modifier
Global
Typical Low
$100.00
Median
$100.00
Typical High
$323.59
Sentara
Setting
Facility
Modifier
Global
Typical Low
$109.65
Median
$134.90
Typical High
$794.33
Sentara
Setting
Professional
Modifier
Global
Typical Low
$144.54
Median
$177.83
Typical High
$794.33
United
Setting
Facility
Modifier
Global
Typical Low
$501.19
Median
$2,818.38
Typical High
$5,370.32
United
Setting
Professional
Modifier
Global
Typical Low
$95.50
Median
$151.36
Typical High
$251.19