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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
$143.12 / $224.36 / $239.53
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$137.04 / $218.73 / $310.86
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.01 / $240.03 / $417.61
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$147.97 / $244.02 / $379.70
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$143.12 / $224.36 / $373.09
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.50 / $277.42 / $387.03