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Removal Of Foreign Object From Mouth Lining

Montana rates for HCPCS 40804

This service removes an object that has become lodged in the soft tissue lining the inside of the lips or cheeks, known as the vestibule of the mouth. It covers a straightforward removal that does not require extensive surgical work to reach or extract the object. The area is examined and the material is taken out, often under local anesthesia.

Rates data updated October 2026.

How much does Removal Of Foreign Object From Mouth Lining cost?

$200

Typical negotiated rate. In Montana, October 2026.

Insurers have agreed to pay about $200 for this service. The price depends on where it is billed: about $195 from a physician practice, and about $240 from a hospital or other facility.

These are rates insurers have negotiated with providers, not the amount a patient is billed. What you owe depends on your plan's deductible and coinsurance. Based on rates published by 6 insurance carriers under federal price transparency rules.

Prices by location type

Billed byTypicalRange
Physician practiceA doctor's office, clinic or independent provider$195$162 to $302
FacilityA hospital or hospital-owned outpatient department$240$200 to $363

How much rates vary

Facilitymedian $240 · 10th to 90th $191 to $417Professionalmedian $195 · 10th to 90th $107 to $339
$100$200$500$1Kfacility $240professional $195

Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.

Rates by insurance carrier

Insurance Carrier
Aetna
Setting
Professional
Modifier
None
Typical Low
$114.82
Median
$194.98
Typical High
$549.54
BCBS Montana
Setting
Professional
Modifier
None
Typical Low
$162.18
Median
$181.97
Typical High
$302.00
Cigna
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
Cigna
Setting
Professional
Modifier
None
Typical Low
$181.97
Median
$208.93
Typical High
$302.00
MountainHealth Co-op
Setting
Facility
Modifier
None
Typical Low
$194.98
Median
$234.42
Typical High
$389.05
MountainHealth Co-op
Setting
Professional
Modifier
None
Typical Low
$128.82
Median
$213.80
Typical High
$380.19
Providence
Setting
Facility
Modifier
None
Typical Low
$181.97
Median
$181.97
Typical High
$181.97
Providence
Setting
Professional
Modifier
None
Typical Low
$79.43
Median
$181.97
Typical High
$302.00
United
Setting
Facility
Modifier
None
Typical Low
$602.56
Median
$1,000.00
Typical High
$1,862.09
United
Setting
Professional
Modifier
None
Typical Low
$190.55
Median
$275.42
Typical High
$363.08

Where Montana sits

The same service costs 3.8 times more in Wisconsin than in Hawaii. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.

Montana· 37th of 51

$200

WI $589HI $155

Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.