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Removal Of Foreign Object From Mouth Lining

Alaska rates for HCPCS 40804

This service removes an object that has become lodged in the soft tissue lining the inside of the lips or cheeks, known as the vestibule of the mouth. It covers a straightforward removal that does not require extensive surgical work to reach or extract the object. The area is examined and the material is taken out, often under local anesthesia.

Rates data updated July 2026.

Facilitymedian $282 · 10th–90th $148$1,3180%5%10th90th$282Professionalmedian $589 · 10th–90th $155$1,0470%10%10th90th$589$100.0$200.0$500.0$1.0K$2.0K$5.0K$10.0K

Distribution of negotiated rates across all payers (price axis is log-scale). Facility and professional rates are different services and are charted separately. Small sample; interpret with caution. Need provider-level prices? Contact us.

Insurance Carrier
Aetna
Setting
Facility
Modifier
Global
Typical Low
$331.13
Median
$602.56
Typical High
$14,125.38
Aetna
Setting
Professional
Modifier
Global
Typical Low
$114.82
Median
$316.23
Typical High
$933.25
Cigna
Setting
Professional
Modifier
Global
Typical Low
$102.33
Median
$169.82
Typical High
$380.19
Moda Health
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$263.03
Typical High
$933.25
Moda Health
Setting
Professional
Modifier
Global
Typical Low
$288.40
Median
$630.96
Typical High
$1,202.26
Premera BCBS
Setting
Professional
Modifier
Global
Typical Low
$467.74
Median
$776.25
Typical High
$1,071.52
Providence
Setting
Facility
Modifier
Global
Typical Low
$138.04
Median
$263.03
Typical High
$933.25
Providence
Setting
Professional
Modifier
Global
Typical Low
$109.65
Median
$257.04
Typical High
$426.58
United
Setting
Professional
Modifier
Global
Typical Low
$162.18
Median
$380.19
Typical High
$1,000.00