42104 (CPT) by state — Price Transparency

CPT · across United States

42104 — Excision Lesion Mouth Roof

State-by-state median negotiated rates. Lower bars are cheaper states; the range bar shows the IQR (25th to 75th percentile within each state).

$3,108 National median

$657 – $4,262 IQR (p25 – p75)

2,130 hospitals filing

54 states

View hospital-by-hospital → Raw rate rows →

Estimate your cost

What would you pay?

Plug in your deductible, what you've already spent against it, your OOP-max, and your coinsurance %. We'll math the rest. Math reference: methodology.

This estimate runs on the hospital’s facility charge only. The surgeon’s and anesthesiologist’s fees are billed separately and aren’t in this number — your EOB shows your complete total.

Uninsured estimates use the cash / self-pay median for this code: $1,416.

I am… Annual deductible (assumed — typical plan) Already spent this year

Checked your insurer’s portal? Enter your remaining deductible and out-of-pocket max above/below and leave “already spent” at 0.

Out-of-pocket max (assumed — typical plan) Coinsurance % (after deductible)

Loading estimate…

Median negotiated rate, by state

Ranked by typical (median) negotiated price. Hover for state-level IQR.

Median negotiated rate by state for 42104 (CPT), with interquartile range
State	Median	p25	p75
ID	$5,477	$3,326	$7,113
NC	$4,560	$2,998	$4,833
CA	$4,018	$564	$4,682
RI	$3,932	$3,380	$6,343
ND	$3,869	$3,243	$7,005
DE	$3,820	$3,583	$5,593
SD	$3,707	$3,285	$4,385
OR	$3,602	$3,336	$5,288
MA	$3,597	$2,181	$4,494
NJ	$3,544	$3,544	$4,771
WA	$3,486	$3,486	$5,727
FL	$3,462	$2,064	$7,324
AZ	$3,457	$1,984	$3,713
MD	$3,429	$3,144	$4,099
VA	$3,373	$2,550	$5,353
GA	$3,368	$2,636	$5,051
HI	$3,366	$2,330	$4,014
DC	$3,315	$2,589	$3,740
OK	$3,304	$1,130	$5,617
NM	$3,298	$1,738	$5,757
SC	$3,277	$2,484	$5,691
CO	$3,259	$1,329	$4,821
ME	$3,231	$565	$4,356
NE	$3,224	$2,641	$3,972
CT	$3,217	$763	$4,042
PA	$3,208	$455	$4,741
WI	$3,184	$2,354	$4,950
WV	$3,180	$206	$3,411
MN	$3,104	$461	$3,405
OH	$3,091	$1,477	$3,894
MS	$3,087	$2,749	$5,300
KY	$3,040	$2,368	$3,935
AR	$2,974	$2,373	$3,299
MO	$2,969	$776	$4,178
AL	$2,939	$1,724	$3,593
KS	$2,902	$268	$3,965
NY	$2,778	$1,395	$4,139
TN	$2,500	$525	$3,109
PR	$2,365	$2,365	$2,365
LA	$2,271	$1,022	$3,452
NV	$2,136	$920	$3,656
TX	$1,980	$158	$3,331
IA	$1,775	$200	$3,227
IL	$1,700	$424	$3,624
AS	$1,356	$179	$2,533
AK	$1,109	$624	$4,285
NH	$864	$309	$2,990
GU	$596	$596	$596
MT	$522	$233	$3,285
WY	$484	$255	$564
MI	$343	$121	$3,019
VT	$305	$204	$3,268
IN	$213	$151	$3,410
UT	$168	$104	$3,109

Sortable, filterable data table. Use the column headers to sort, the filter row to narrow results.
State	Median	p25	p75	Min	Max	Hospitals	Payers	Rates

ID	$5,477	$3,326	$7,113	$83	$12,990	21	148	932
NC	$4,560	$2,998	$4,833	$75	$10,074	45	108	2,076
CA	$4,018	$564	$4,682	<$1	$47,662	182	607	6,077
RI	$3,932	$3,380	$6,343	$387	$20,935	5	7	68
ND	$3,869	$3,243	$7,005	$81	$12,855	12	59	233
DE	$3,820	$3,583	$5,593	$209	$17,295	4	8	32
SD	$3,707	$3,285	$4,385	$154	$8,927	11	115	435
OR	$3,602	$3,336	$5,288	$120	$28,602	22	298	934
MA	$3,597	$2,181	$4,494	$1	$50,000	33	243	793
NJ	$3,544	$3,544	$4,771	$11	$28,828	45	160	3,044
WA	$3,486	$3,486	$5,727	$61	$24,481	45	160	2,492
FL	$3,462	$2,064	$7,324	<$1	$986,568	124	236	4,240
AZ	$3,457	$1,984	$3,713	$6	$39,491	33	93	935
MD	$3,429	$3,144	$4,099	$226	$4,643	1 ⚠ thin data	15	34
VA	$3,373	$2,550	$5,353	$8	$19,276	38	61	903
GA	$3,368	$2,636	$5,051	$93	$50,000	55	97	1,493
HI	$3,366	$2,330	$4,014	$106	$8,879	13	26	175
DC	$3,315	$2,589	$3,740	$243	$8,290	4	15	48
OK	$3,304	$1,130	$5,617	$29	$11,857	43	57	580
NM	$3,298	$1,738	$5,757	$118	$20,474	11	40	196
SC	$3,277	$2,484	$5,691	$1	$50,000	43	69	1,044
CO	$3,259	$1,329	$4,821	$30	$15,513	53	77	1,131
ME	$3,231	$565	$4,356	$114	$19,397	21	16	225
NE	$3,224	$2,641	$3,972	$42	$16,454	26	96	827
CT	$3,217	$763	$4,042	$206	$14,003	17	37	282
PA	$3,208	$455	$4,741	$1	$36,849	69	204	3,809
WI	$3,184	$2,354	$4,950	$2	$24,261	80	179	1,843
WV	$3,180	$206	$3,411	$39	$22,660	17	64	366
MN	$3,104	$461	$3,405	$68	$50,000	57	86	1,135
OH	$3,091	$1,477	$3,894	$84	$14,555	79	352	2,100
MS	$3,087	$2,749	$5,300	$187	$76,988	18	151	553
KY	$3,040	$2,368	$3,935	$96	$8,119	39	71	954
AR	$2,974	$2,373	$3,299	$34	$18,190	23	223	881
MO	$2,969	$776	$4,178	$99	$24,843	42	175	1,504
AL	$2,939	$1,724	$3,593	$1	$71,402	30	140	580
KS	$2,902	$268	$3,965	$5	$22,789	31	168	911
NY	$2,778	$1,395	$4,139	$11	$45,911	96	303	6,094
TN	$2,500	$525	$3,109	<$1	$8,001	48	145	2,674
PR	$2,365	$2,365	$2,365	$2,365	$2,602	1 ⚠ thin data	5	5
LA	$2,271	$1,022	$3,452	$29	$17,881	36	133	1,487
NV	$2,136	$920	$3,656	$121	$10,663	21	213	641
TX	$1,980	$158	$3,331	<$1	$24,076	219	298	8,273
IA	$1,775	$200	$3,227	$1	$10,868	34	158	737
IL	$1,700	$424	$3,624	$8	$74,066	72	230	1,852
AS	$1,356	$179	$2,533	$179	$2,533	1 ⚠ thin data	1	6
AK	$1,109	$624	$4,285	$72	$15,448	6	27	76
NH	$864	$309	$2,990	$33	$24,925	13	31	459
GU	$596	$596	$596	$596	$596	1 ⚠ thin data	4	4
MT	$522	$233	$3,285	$86	$9,283	13	44	179
WY	$484	$255	$564	$121	$6,299	10	46	88
MI	$343	$121	$3,019	<$1	$13,945	71	322	2,612
VT	$305	$204	$3,268	<$1	$4,903	8	43	213
IN	$213	$151	$3,410	$31	$27,470	49	210	2,301
UT	$168	$104	$3,109	$104	$8,497	33	42	1,353