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South Dakota rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $182 · 10th–90th $107–$4,3650%10%20%10th90th$182Professionalmedian $195 · 10th–90th $107–$3890%10%20%10th90th$195$100.0$200.0$500.0$1.0K$2.0K

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
$107.15 / $181.97 / $4,365.16
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $165.96 / $257.04
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$281.84 / $354.81 / $588.84
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$141.25 / $251.19 / $549.54
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$173.78 / $371.54 / $1,412.54
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$263.03 / $269.15 / $436.52
Midlands
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$245.47 / $245.47 / $389.05
Sanford Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$186.21 / $269.15 / $380.19
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,995.26 / $1,995.26 / $1,995.26
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$147.91 / $281.84 / $524.81
Wellmark
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$229.09 / $281.84 / $467.74