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Illinois rates for HCPCS 40804

Rmvl Embedded Fb Vestibule Mouth Smpl

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$187.19 / $528.45 / $5,405.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$108.26 / $187.19 / $314.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$961.63 / $1,338.94 / $2,237.05
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$135.22 / $201.50 / $324.95
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$124.52 / $216.29 / $357.24
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$157.32 / $280.97 / $546.91
Hally Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$142.35 / $145.83 / $260.89
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $301.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$749.00 / $2,588.00 / $5,026.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$200.11 / $296.82 / $488.85