Biopsy of mouth
Medicare pricing data for 2,934 providers across 50 states
Prices vary significantly by location — from $87 in Vermont to $189 in District of Columbia. Where you get this procedure matters more than almost any other factor. This is a specialized procedure with relatively few Medicare claims. Pricing data may be less reliable due to smaller sample sizes. Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.
💡 What You Should Know
Biopsy of mouth (HCPCS code 40808) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $152.82, but hospitals typically charge $462.57 — a 3.0x markup. Prices vary significantly by state and provider.
🏷️ Typical Out-of-Pocket Cost
Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $152.82, your out-of-pocket cost would be approximately $30.56. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.
What Hospitals Charge vs. What Medicare Pays
Hospitals charge 3.0x more than what Medicare allows for this procedure. Medicare actually pays $113.58 on average.
Cost by State
Medicare-allowed amounts vary significantly by state
| State | Allowed Cost | Hospital Charge | Providers | Services | vs. National |
|---|---|---|---|---|---|
| District of Columbia | $189 | $418 | 10 | 29 | +23.6% |
| New Jersey | $180 | $531 | 76 | 184 | +17.6% |
| Alaska | $177 | $700 | 11 | 33 | +15.5% |
| Massachusetts | $176 | $621 | 101 | 237 | +14.9% |
| Connecticut | $175 | $528 | 28 | 52 | +14.2% |
| Maryland | $170 | $387 | 53 | 141 | +11.5% |
| Wyoming | $170 | $407 | 6 | 11 | +11.1% |
| Rhode Island | $169 | $291 | 5 | 15 | +10.8% |
| Hawaii | $168 | $430 | 6 | 14 | +10.1% |
| Montana | $164 | $383 | 16 | 45 | +7.6% |
| Colorado | $163 | $492 | 58 | 105 | +6.6% |
| South Dakota | $162 | $382 | 10 | 15 | +5.7% |
| New York | $160 | $592 | 174 | 434 | +5.0% |
| Illinois | $159 | $537 | 102 | 274 | +4.1% |
| Delaware | $158 | $446 | 8 | 21 | +3.3% |
| Washington | $157 | $396 | 61 | 116 | +2.4% |
| Virginia | $156 | $389 | 77 | 207 | +2.3% |
| Texas | $155 | $503 | 179 | 400 | +1.7% |
| Michigan | $155 | $410 | 109 | 221 | +1.5% |
| Wisconsin | $154 | $742 | 69 | 130 | +0.9% |
| Georgia | $154 | $441 | 69 | 131 | +0.9% |
| New Hampshire | $154 | $471 | 22 | 33 | +0.9% |
| Minnesota | $154 | $670 | 91 | 218 | +0.7% |
| Pennsylvania | $152 | $442 | 157 | 417 | -0.4% |
| Florida | $152 | $410 | 196 | 419 | -0.5% |
| Iowa | $152 | $431 | 42 | 73 | -0.5% |
| North Dakota | $152 | $493 | 7 | 17 | -0.6% |
| Oregon | $152 | $500 | 47 | 79 | -0.7% |
| Kansas | $151 | $347 | 38 | 114 | -1.1% |
| Indiana | $150 | $444 | 72 | 182 | -1.9% |
| California | $150 | $471 | 263 | 761 | -2.0% |
| Oklahoma | $150 | $409 | 37 | 65 | -2.1% |
| South Carolina | $148 | $364 | 51 | 92 | -3.1% |
| Missouri | $148 | $448 | 69 | 145 | -3.2% |
| Kentucky | $147 | $383 | 46 | 112 | -3.5% |
| Tennessee | $147 | $437 | 70 | 128 | -3.7% |
| Louisiana | $146 | $362 | 41 | 79 | -4.4% |
| West Virginia | $146 | $416 | 14 | 24 | -4.5% |
| North Carolina | $146 | $504 | 103 | 236 | -4.7% |
| Nebraska | $145 | $469 | 23 | 45 | -5.3% |
| Utah | $142 | $481 | 28 | 88 | -6.9% |
| Alabama | $140 | $255 | 35 | 61 | -8.7% |
| Mississippi | $139 | $363 | 25 | 55 | -9.4% |
| Ohio | $138 | $355 | 89 | 460 | -9.8% |
| Idaho | $138 | $422 | 15 | 34 | -9.9% |
| Arizona | $137 | $342 | 62 | 265 | -10.1% |
| Arkansas | $136 | $282 | 23 | 40 | -11.3% |
| Nevada | $128 | $358 | 19 | 56 | -15.9% |
| Maine | $97 | $319 | 11 | 24 | -36.8% |
| Vermont | $87 | $112 | 6 | 20 | -43.3% |
⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.
💊 Need post-procedure medications? Check costs on OpenPrescriber