go back

Virginia rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$131.50 / $3,633.00 / $8,920.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$122.03 / $168.59 / $232.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,735.00 / $2,390.00 / $2,954.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$114.54 / $178.64 / $263.60
CareFirst
Facility/Professional
Professional
Modifier
Low / Median / High Price
$133.24 / $191.87 / $3,774.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$132.10 / $213.38 / $361.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$187.93 / $225.52 / $278.14
Medcost
Facility/Professional
Facility
Modifier
Low / Median / High Price
$134.83 / $222.24 / $350.15
Medcost
Facility/Professional
Professional
Modifier
Low / Median / High Price
$231.00 / $269.54 / $402.05
Sentara
Facility/Professional
Facility
Modifier
Low / Median / High Price
$115.68 / $161.91 / $1,683.00
Sentara
Facility/Professional
Professional
Modifier
Low / Median / High Price
$170.53 / $266.94 / $1,683.00
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,911.00 / $3,533.00 / $5,340.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$160.34 / $257.00 / $424.55