Price Checker / CPT 42106
How much does Excision Lesion Mouth Roof cost?
CPT 42106 · Based on 2026 Medicare rates and hospital-published pricing
A fair cash price for this is roughly $390–$780.
Fair price
$390–$780
What this should cost
With insurance
~$2,750
Typical out-of-pocket
Overcharged if over
$980
Push back above this
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 42106 refers to excision lesion mouth roof (billing description: "Excision lesion mouth roof"). Under the 2026 Medicare Physician Fee Schedule, it is reimbursed at $150 in a facility (hospital or surgery center) and $262 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.