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Louisiana rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.18 / $2,511.89 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$109.65 / $181.97 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$120.23 / $831.76 / $1,862.09
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $204.17 / $295.12
Christus
Facility/Professional
Facility
Modifier
Low / Median / High Price
$39.81 / $39.81 / $39.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $194.98 / $316.23
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$467.74 / $1,380.38 / $3,630.78
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $204.17 / $331.13