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Michigan rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $4,898 · 10th–90th $141–$4,8980%50%10th$4,898Professionalmedian $182 · 10th–90th $110–$3020%10%20%10th90th$182$50.0$200.0$1.0K$5.0K

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
$141.25 / $4,897.79 / $4,897.79
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $177.83 / $288.40
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$30.20 / $30.20 / $30.20
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $177.83 / $316.23
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $186.21 / $302.00
Health Alliance Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$229.09 / $630.96 / $4,897.79
Health Alliance Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $229.09 / $354.81
Priority Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $162.18 / $269.15
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $2,398.83 / $5,623.41
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $213.80 / $316.23