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Alaska rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$319.50 / $9,577.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$584.12 / $788.23 / $1,064.18
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$379.33 / $379.33 / $605.28
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.46 / $817.77 / $1,305.05
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$290.30 / $753.90 / $1,243.20
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.40 / $768.00 / $1,234.00
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$140.46 / $817.77 / $1,305.05
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$236.77 / $652.24 / $1,219.81
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$454.08 / $730.50 / $1,044.38