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Ohio rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $2,239 · 10th–90th $170$11,4820%10%10th90th$2,239Professionalmedian $182 · 10th–90th $110$3630%10%20%10th90th$182$1.0$5.0$20.0$100.0$500.0$2.0K$10.0K

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
$123.03 / $3,715.35 / $11,748.98
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $181.97 / $501.19
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$707.95 / $2,187.76 / $3,981.07
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$102.33 / $165.96 / $295.12
CareSource
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $120.23 / $131.83
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $218.78 / $363.08
Medical Mutual of Ohio
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$21,379.62 / $21,379.62 / $21,379.62
Medical Mutual of Ohio
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $223.87 / $363.08
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $32.36 / $33.11
SummaCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$100.00 / $100.00 / $1,122.02
SummaCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $204.17 / $316.23
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$691.83 / $2,398.83 / $5,248.07
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $186.21 / $309.03