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Montana rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$116.13 / $630.16 / $1,064.18
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$47,000.00 / $81,499.99 / $94,999.99
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.88 / $180.88 / $299.70
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$180.88 / $180.88 / $180.88
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$180.88 / $223.49 / $359.09
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$116.00 / $341.90 / $387.72
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$115.67 / $196.63 / $354.01
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$268.26 / $336.64 / $520.76