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New York rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $3,236 · 10th–90th $219$7,4130%10%10th90th$3,236Professionalmedian $200 · 10th–90th $117$5010%10%20%10th90th$200$50.0$200.0$1.0K$5.0K$20.0K

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
$186.21 / $2,818.38 / $8,128.31
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $194.98 / $436.52
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,819.70 / $3,630.78 / $5,011.87
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$144.54 / $190.55 / $501.19
CDPHP
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $4,073.80
CDPHP
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $162.18 / $275.42
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $199.53 / $53,703.18
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $309.03 / $776.25
Emblem Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$34.67 / $131.83 / $309.03
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $302.00 / $436.52
Excellus BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $257.04 / $398.11
MVP Health Care
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$134.90 / $50,118.72 / $75,857.76
MVP Health Care
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$239.88 / $295.12 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,862.09 / $3,467.37 / $7,244.36
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$104.71 / $223.87 / $457.09
Univera
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$93.33 / $138.04 / $416.87
Univera
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $251.19 / $398.11