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Pennsylvania rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $4,266 · 10th–90th $347$8,5110%10%10th90th$4,266Professionalmedian $182 · 10th–90th $110$3550%10%20%10th90th$182$10.0$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
$346.74 / $4,786.30 / $8,511.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $173.78 / $338.84
Capital Blue Cross
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$5,011.87 / $8,511.38 / $77,624.71
Capital Blue Cross
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $199.53 / $199.53
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$123.03 / $208.93 / $323.59
Emblem Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$346.74 / $346.74 / $354.81
Geisinger
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $239.88 / $371.54
Martin's Point
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$537.03 / $3,801.89 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $181.97 / $309.03
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $354.81 / $489.78
UPMC Health Plan
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$72.44 / $144.54 / $407.38
UPMC Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$72.44 / $112.20 / $309.03
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,096.48 / $2,454.71 / $5,011.87
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $177.83 / $316.23