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Idaho rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$389.05 / $4,466.84 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $234.42 / $549.54
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$48.98 / $208.93 / $2,344.23
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $295.12 / $389.05
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $218.78 / $338.84
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.90 / $331.13 / $776.25
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $234.42 / $398.11
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $32.36 / $33.11
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,318.26 / $1,819.70 / $2,884.03
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $251.19 / $398.11
Select Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$151.36 / $199.53 / $1,698.24
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,467.37 / $6,165.95 / $7,762.47
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$128.82 / $218.78 / $380.19