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Biopsy Of The Roof Of The Mouth

Wisconsin 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 $3,388 · 10th–90th $138$6,0260%5%10%10th90th$3,388Professionalmedian $178 · 10th–90th $107$5750%5%10%10th90th$178$50.0$200.0$1.0K$5.0K

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
$123.03
Median
$229.09
Typical High
$1,905.46
Aetna
Setting
Professional
Modifier
Global
Typical Low
$104.71
Median
$147.91
Typical High
$398.11
Anthem BCBS
Setting
Facility
Modifier
Global
Typical Low
$2,344.23
Median
$4,570.88
Typical High
$7,079.46
Anthem BCBS
Setting
Professional
Modifier
Global
Typical Low
$138.04
Median
$251.19
Typical High
$676.08
Cigna
Setting
Facility
Modifier
Global
Typical Low
$389.05
Median
$457.09
Typical High
$724.44
Cigna
Setting
Professional
Modifier
Global
Typical Low
$131.83
Median
$263.03
Typical High
$588.84
DeanCare
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$162.18
Typical High
$2,754.23
DeanCare
Setting
Professional
Modifier
Global
Typical Low
$204.17
Median
$288.40
Typical High
$436.52
Medica
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$165.96
Typical High
$3,890.45
Medica
Setting
Professional
Modifier
Global
Typical Low
$151.36
Median
$323.59
Typical High
$1,096.48
Molina
Setting
Professional
Modifier
Global
Typical Low
$32.36
Median
$33.11
Typical High
$147.91
Network Health
Setting
Facility
Modifier
Global
Typical Low
$223.87
Median
$3,890.45
Typical High
$4,570.88
Network Health
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$302.00
Typical High
$478.63
Prevea360
Setting
Facility
Modifier
Global
Typical Low
$107.15
Median
$147.91
Typical High
$245.47
Quartz
Setting
Professional
Modifier
Global
Typical Low
$165.96
Median
$295.12
Typical High
$501.19
Quartz
Setting
Facility
Modifier
Global
Typical Low
$186.21
Median
$3,890.45
Typical High
$3,890.45
Quartz
Setting
Professional
Modifier
Global
Typical Low
$123.03
Median
$371.54
Typical High
$1,047.13
Security Health
Setting
Professional
Modifier
Global
Typical Low
$398.11
Median
$398.11
Typical High
$549.54
Security Health
Setting
Professional
Modifier
Global
Typical Low
$346.74
Median
$549.54
Typical High
$741.31
United
Setting
Facility
Modifier
Global
Typical Low
$2,754.23
Median
$3,630.78
Typical High
$6,025.60
United
Setting
Professional
Modifier
Global
Typical Low
$112.20
Median
$186.21
Typical High
$501.19