Price Checker / CPT 42100
How much does Biopsy Roof Of Mouth cost?
CPT 42100 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is around 65x the fair price — among the most extreme markups. Dispute this.
Fair price
$220–$450
What this should cost
With insurance
~$2,400
Typical out-of-pocket
Overcharged if over
$560
Push back above this
The average hospital charge of $22,228 is $21,888 over the fair price (about 65x the fair rate).
What hospitals charge for Biopsy Roof Of Mouth
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Astria Sunnyside Hospital SUNNYSIDE, WA | — | — | 14722% |
Were you billed for this procedure?
Send us your bill and we'll compare every line item against Medicare rates and your hospital's published prices. Free review, no obligation.
About Biopsy Roof Of Mouth
CPT code 42100 refers to biopsy roof of mouth (billing description: "Biopsy roof of mouth"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $102 in a facility (hospital or surgery center) and $150 in a doctor's office.
The Medicare rate is the closest thing to an objective "what this work is actually worth." A fair cash price for the uninsured is generally 1.5–3x that rate. Hospital sticker (gross) charges are often far higher — but almost nobody actually pays them.
What to do if you were overcharged
- 1Send us your bill — we'll identify this code and compare it against the rates shown above.
- 2Get a dispute letter — citing the Medicare rate and your hospital's own published pricing data.
- 3We negotiate for you — 25% of savings, no savings = no fee.