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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
$387.79 / $650.59 / $10,516.81
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.25 / $311.00 / $546.72
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$158.06 / $216.02 / $331.15
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$137.58 / $306.74 / $546.72
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.60 / $232.24 / $382.98
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $306.74
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,031.25 / $1,837.93 / $2,746.53
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$211.55 / $229.28 / $379.91
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$3,450.00 / $6,124.00 / $7,609.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.39 / $292.05 / $473.76