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Arizona rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $2,042 · 10th–90th $129–$6,3100%5%10%10th90th$2,042Professionalmedian $186 · 10th–90th $110–$3800%10%10th90th$186$50.0$200.0$1.0K$5.0K

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

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,737.80 / $3,890.45 / $7,943.28
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $181.97 / $380.19
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$33.88 / $147.91 / $288.40
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $229.09 / $1,023.29
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $194.98 / $346.74
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $204.17 / $2,454.71
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $251.19 / $1,412.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $1,659.59 / $4,677.35
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $181.97 / $302.00