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Arkansas rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$154.88 / $263.03 / $2,041.74
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.15 / $169.82 / $234.42
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $1,148.15
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $162.18 / $263.03
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$67.61 / $67.61 / $67.61
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$134.90 / $204.17 / $323.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$602.56 / $1,288.25 / $2,570.40
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $181.97 / $323.59