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Utah rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $3,162 · 10th–90th $170–$4,5710%10%10th90th$3,162Professionalmedian $209 · 10th–90th $115–$4170%10%10th90th$209$50.0$100.0$200.0$500.0$1.0K$2.0K$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
$169.82 / $3,162.28 / $4,570.88
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $204.17 / $436.52
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $223.87 / $346.74
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $416.87
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,348.96 / $1,819.70 / $2,818.38
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$165.96 / $275.42 / $446.68
Select Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$134.90 / $223.87 / $478.63
U of Utah Health Plan
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $257.04 / $371.54
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$870.96 / $4,466.84 / $5,128.61
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$117.49 / $199.53 / $354.81