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Missouri rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$165.28 / $4,261.00 / $12,154.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$110.12 / $172.39 / $200.21
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$821.00 / $1,963.00 / $4,852.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$118.00 / $185.65 / $305.58
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$120.25 / $227.91 / $408.45
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$106.31 / $232.28 / $2,332.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.34 / $428.71 / $1,409.04
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,216.00 / $2,332.00 / $3,071.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$203.18 / $321.02 / $502.85