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Oregon rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$229.09 / $457.09 / $10,471.29
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.82 / $199.53 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$173.78 / $323.59 / $537.03
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $323.59 / $512.86
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$158.49 / $281.84 / $489.78
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$190.55 / $316.23 / $478.63
Pacific Source
Facility/Professional
Facility
Modifier
Low / Median / High Price
$245.47 / $354.81 / $398.11
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$144.54 / $257.04 / $457.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $288.40 / $489.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,187.76 / $2,884.03 / $3,467.37
Regence BlueShield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$218.78 / $346.74 / $489.78
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,698.24 / $4,897.79 / $7,413.10
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$177.83 / $302.00 / $501.19