go back

Delaware rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$7,244.36 / $7,244.36 / $7,244.36
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $199.53 / $457.09
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $199.53 / $338.84
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$112.20 / $177.83 / $295.12