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Washington rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $372 · 10th–90th $209$7,9430%10%20%10th90th$372Professionalmedian $240 · 10th–90th $126$4900%10%10th90th$240$10.0$50.0$200.0$1.0K$5.0K$20.0K

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
$218.78 / $436.52 / $18,620.87
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$114.82 / $208.93 / $501.19
Asuris Northwest Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,698.24 / $2,398.83 / $4,897.79
Asuris Northwest Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $288.40 / $446.68
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $309.03 / $549.54
Kaiser Permanente
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$177.83 / $309.03 / $831.76
Kaiser Permanente
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$177.83 / $288.40 / $489.78
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $56.23
Pacific Source
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$213.80 / $380.19 / $380.19
Premera BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$257.04 / $257.04 / $263.03
Premera BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$158.49 / $263.03 / $489.78
Regence BlueShield
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,659.59 / $2,511.89 / $4,897.79
Regence BlueShield
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$190.55 / $302.00 / $446.68
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$851.14 / $3,162.28 / $6,165.95
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$154.88 / $257.04 / $467.74
Wellpoint
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$131.83 / $245.47 / $302.00