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Wisconsin rates for HCPCS 40804

Removal of embedded foreign body, vestibule of mouth; simple

Facilitymedian $2,884 · 10th–90th $240$5,7540%10%10th90th$2,884Professionalmedian $224 · 10th–90th $120$7080%10%10th90th$224$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
$144.54 / $239.88 / $407.38
Aetna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$112.20 / $186.21 / $407.38
Anthem BCBS
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$1,584.89 / $3,090.30 / $5,754.40
Anthem BCBS
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$181.97 / $346.74 / $933.25
Cigna
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$512.86 / $602.56 / $954.99
Cigna
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $416.87 / $812.83
DeanCare
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $389.05 / $3,801.89
DeanCare
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$257.04 / $354.81 / $588.84
Medica
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$120.23 / $2,398.83 / $5,754.40
Medica
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$204.17 / $363.08 / $1,148.15
Molina
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$32.36 / $33.11 / $295.12
Network Health
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$275.42 / $3,890.45 / $4,570.88
Network Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$275.42 / $501.19 / $741.31
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$223.87 / $407.38 / $724.44
Quartz
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$309.03 / $1,288.25 / $1,288.25
Quartz
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$162.18 / $645.65 / $1,412.54
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$407.38 / $407.38 / $707.95
Security Health
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$512.86 / $645.65 / $977.24
United
Facility/Professional
Facility
Modifier
Typical Low / Median / Typical High
$2,754.23 / $3,311.31 / $6,606.93
United
Facility/Professional
Professional
Modifier
Typical Low / Median / Typical High
$138.04 / $288.40 / $741.31