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Maine rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$123.03 / $204.17 / $371.54
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$117.49 / $213.80 / $323.59
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $239.88 / $380.19
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$144.54 / $257.04 / $398.11
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$138.04 / $234.42 / $457.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.91 / $229.09 / $389.05