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Massachusetts rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $316 · 10th–90th $138$5,1290%10%10th90th$316Professionalmedian $224 · 10th–90th $117$5010%5%10%10th90th$224$50.0$200.0$1.0K$5.0K$20.0K

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
$138.04 / $2,818.38 / $5,623.41
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $186.21 / $389.05
AllWays Health Partners
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $954.99 / $4,786.30
AllWays Health Partners
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $234.42 / $616.60
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$144.54 / $144.54 / $323.59
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$50.12 / $50.12 / $50.12
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $288.40 / $549.54
Fallon Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $173.78 / $3,630.78
Fallon Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $302.00 / $416.87
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,778.28 / $3,630.78 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$141.25 / $251.19 / $524.81
Mass General Brigham
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$56.23 / $954.99 / $4,786.30
Mass General Brigham
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $234.42 / $616.60
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,258.93 / $3,162.28 / $8,511.38
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $275.42 / $562.34