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Texas rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $1,514 · 10th–90th $151$6,1660%5%10%10th90th$1,514Professionalmedian $182 · 10th–90th $112$3020%20%10th90th$182$10.0$50.0$200.0$1.0K$5.0K

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
$295.12 / $3,715.35 / $12,022.64
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $181.97 / $281.84
BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$562.34 / $1,258.93 / $2,691.53
BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $181.97 / $288.40
Christus
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$112.20 / $112.20 / $112.20
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $218.78 / $380.19
Lucent Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$54.95 / $56.23 / $1,288.25
Lucent Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$1,412.54 / $1,659.59 / $1,659.59
Moda Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $229.09 / $3,311.31
Moda Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $204.17 / $380.19
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $95.50
Oscar Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$5.01 / $467.74 / $537.03
Providence
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$114.82 / $204.17 / $380.19
Providence
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $218.78 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$724.44 / $1,995.26 / $4,073.80
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$109.65 / $177.83 / $302.00
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$199.53 / $208.93 / $208.93