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Virginia rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $331 · 10th–90th $132–$7,5860%5%10%10th90th$331Professionalmedian $191 · 10th–90th $115–$3240%10%10th90th$191$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
$134.90 / $3,235.94 / $8,912.51
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $181.97 / $275.42
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,137.96 / $2,570.40 / $2,951.21
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$120.23 / $190.55 / $302.00
CareFirst
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $323.59 / $4,365.16
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$125.89 / $208.93 / $354.81
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $245.47 / $660.69
Medcost
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $275.42 / $457.09
Medcost
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$131.83 / $223.87 / $371.54
Sentara
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$109.65 / $165.96 / $4,073.80
Sentara
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$169.82 / $269.15 / $4,073.80
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $3,162.28 / $5,370.32
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$107.15 / $190.55 / $346.74