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West 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
$107.08 / $176.35 / $1,400.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$107.08 / $173.58 / $213.98
CareSource
Facility/Professional
Facility
Modifier
Low / Median / High Price
$112.03 / $123.02 / $146.46
CareSource
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.19 / $130.19 / $130.19
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$197.27 / $197.27 / $197.27
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$130.19 / $234.57 / $559.70
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$146.69 / $214.17 / $329.48