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Illinois rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $1,622 · 10th–90th $186–$7,7620%5%10th90th$1,622Professionalmedian $191 · 10th–90th $112–$3390%10%10th90th$191$50.0$200.0$1.0K$5.0K

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
$186.21 / $1,621.81 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $181.97 / $338.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,023.29 / $1,318.26 / $2,089.30
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $199.53 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $208.93 / $363.08
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $281.84 / $575.44
Hally Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $100.00
Hally Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $144.54 / $263.03
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$776.25 / $2,137.96 / $4,365.16
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$128.82 / $208.93 / $363.08