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Kansas rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $5,495.41 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$104.71 / $177.83 / $316.23
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,122.02 / $1,174.90 / $1,174.90
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$165.96 / $165.96 / $275.42
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.23 / $204.17 / $323.59
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$107.15 / $234.42 / $2,630.27
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $251.19 / $1,412.54
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$707.95 / $1,230.27 / $3,311.31
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$125.89 / $194.98 / $281.84