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Biopsy Of The Roof Of The Mouth

Vermont 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 physician fee. In Vermont, July 2026.

Insurers have agreed to pay about $148 for this service. Most negotiated rates run $117 to $162.

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 4 insurance carriers under federal price transparency rules.

How much rates vary

Professionalmedian $148 · 10th to 90th $117 to $182
$100$200professional $148

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
Professional
Modifier
Global
Typical Low
$117.49
Median
$128.82
Typical High
$177.83
Cigna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$190.55
Typical High
$245.47
MVP Health Care
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$213.80
Typical High
$380.19
United
Setting
Professional
Modifier
Global
Typical Low
$125.89
Median
$181.97
Typical High
$309.03

Where Vermont 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.

Vermont· 43rd 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.