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California rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $4,467 · 10th–90th $1,175$13,4900%10%10th90th$4,467Professionalmedian $209 · 10th–90th $115$6460%5%10%10th90th$209$50.0$200.0$1.0K$5.0K$20.0K

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
$1,318.26 / $10,000.00 / $21,379.62
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $194.98 / $724.44
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,511.89 / $4,466.84 / $12,882.50
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $245.47 / $549.54
Blue Shield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$77.62 / $1,096.48 / $2,187.76
Blue Shield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $234.42 / $512.86
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $223.87 / $512.86
Contra Costa Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$61.66 / $144.54 / $302.00
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $223.87 / $416.87
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $1,288.25
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,659.59 / $1,659.59
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $158.49 / $263.03
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $208.93 / $371.54
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $218.78 / $467.74
Sutter Health Plus
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$389.05 / $389.05 / $660.69
The Alliance
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$63.10 / $104.71 / $234.42
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $4,265.80 / $9,549.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $194.98 / $446.68