Price Checker / CPT 42104
How much does Excision Lesion Mouth Roof cost?
CPT 42104 · Based on 2026 Medicare rates and hospital-published pricing
The average hospital charge is around 15x the fair price — among the most extreme markups. Dispute this.
Fair price
$330–$660
What this should cost
With insurance
~$2,750
Typical out-of-pocket
Overcharged if over
$830
Push back above this
The average hospital charge of $7,569 is $7,069 over the fair price (about 15x the fair rate).
What hospitals charge for Excision Lesion Mouth Roof
From hospital-published transparency (MRF) files. These are the hospitals in our database that list this procedure.
| Hospital | Gross Charge | Cash Rate | vs Medicare |
|---|---|---|---|
| Troy Regional Medical Center TROY, AL | $9,000 | $3,000 | 4020% |
| Dallas County Hospital PERRY, IA | $6,137 | $3,989 | 2709% |
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 Excision Lesion Mouth Roof
CPT code 42104 refers to excision lesion mouth roof (billing description: "Excision lesion mouth roof"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $123 in a facility (hospital or surgery center) and $218 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.