Rmvl embedded fb vestibule mouth smpl (CPT 40804)
40804 is the billing code hospitals use for this service. Prices below are each hospital's own posted facility charge.
Name shown as it appears in hospital billing files.
100 of 309 hospitals post a price for this code. Hospitals that don't post one are left out. We never guess a number.
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| Hospital | Location | Cash price | Gross charge | Medicare pays | × Medicare |
|---|---|---|---|---|---|
| Halifax Health Medical Center | Daytona Beach, FL | $42 | $52.50 | $947.15 | 0.0× |
| Halifax Health | UF Health Medical Center of Deltona | Deltona, FL | $42 | $52.50 | $947.15 | 0.0× |
| Doctors Memorial Hospital | Bonifay, FL | $118.35 | $263 | $947.15 | 0.1× |
| Northwest Florida Community Hospital | Chipley, FL | $140 | $175 | $947.15 | 0.1× |
| Rio Grande Hospital | Del Norte, CO | $208.28 | $277.71 | $956.76 | 0.2× |
| South Lincoln Medical Center | Kemmerer, WY | $234.23 | $312.31 | $926.63 | 0.3× |
| Prowers Medical Center | Lamar, CO | $240.60 | $401 | $956.76 | 0.3× |
| Sublette County Health | Pinedale, WY | $258.30 | $287 | $926.63 | 0.3× |
| Spanish Peaks Regional Health Center | Walsenburg, CO | $286.20 | $318 | $956.76 | 0.3× |
| Montrose Regional Health | Montrose, CO | $312 | $416 | $956.76 | 0.3× |
| Memorial Hospital of Carbon County | Rawlins, WY | $348 | $464 | $926.63 | 0.4× |
| Heart of the Rockies Regional Medical Center | Salida, CO | $365.50 | $430 | $956.76 | 0.4× |
| George Washington University Hospital | Washington, DC | $456.40 | $1,141 | $965.72 | 0.5× |
| Cedar Hill Regional Medical Center GW Health | Washington, DC | $456.40 | $1,141 | $965.72 | 0.5× |
| Sheridan Memorial Hospital | Sheridan, WY | $494.80 | $618.50 | $926.63 | 0.5× |
| Ivinson Memorial Hospital | Laramie, WY | $496 | $496 | $926.63 | 0.5× |
| St. John's Medical Center | Jackson, WY | $499 | $499 | $926.63 | 0.5× |
| Mease Dunedin Hospital | Dunedin, FL | $520.20 | $867 | $947.15 | 0.5× |
| Winter Haven Hospital | Winter Haven, FL | $520.20 | $867 | $947.15 | 0.5× |
| Morton Plant North Bay Hospital | New Port Richey, FL | $520.20 | $867 | $947.15 | 0.5× |
| St. Anthony's Hospital | Saint Petersburg, FL | $520.20 | $867 | $947.15 | 0.5× |
| St. Joseph's Hospital | Tampa, FL | $520.20 | $867 | $947.15 | 0.5× |
| Bartow Regional Medical Center | Bartow, FL | $520.20 | $867 | $947.15 | 0.5× |
| Morton Plant Hospital | Clearwater, FL | $520.20 | $867 | $947.15 | 0.5× |
| South Florida Baptist Hospital | Plant City, FL | $520.20 | $867 | $947.15 | 0.5× |
| Mease Countryside Hospital | Safety Harbor, FL | $520.20 | $867 | $947.15 | 0.5× |
| BayCare Hospital Wesley Chapel | Wesley Chapel, FL | $520.20 | $867 | $947.15 | 0.5× |
| Manatee Memorial Hospital | Bradenton, FL | $581.20 | $1,453 | $947.15 | 0.6× |
| Lakewood Ranch Medical Center | Bradenton, FL | $581.20 | $1,453 | $947.15 | 0.6× |
| UF Health Leesburg Hospital | Leesburg, FL | $605 | $1,100 | $947.15 | 0.6× |
| Flagler Hospital | Saint Augustine, FL | $633.60 | $1,152 | $947.15 | 0.7× |
| UF Health Shands Hospital | Gainesville, FL | $633.60 | $1,152 | $947.15 | 0.7× |
| UF Health Spanish Plaines Hospital | The Villages, FL | $633.60 | $1,152 | $947.15 | 0.7× |
| Baylor University Medical Center (Baylor Scott & White) | Dallas, TX | $640.74 | $1,067.90 | $911.12 | 0.7× |
| Lake Butler Hospital | Lake Butler, FL | $651.95 | $651.95 | $947.15 | 0.7× |
| Doctors Memorial Hospital | Perry, FL | $676 | $1,690 | $947.15 | 0.7× |
| Denver Health Medical Center | Denver, CO | $677.07 | $1,934.46 | $956.76 | 0.7× |
| Naples Community Hospital | Naples, FL | $743.20 | $1,858 | $947.15 | 0.8× |
| Aspen Valley Hospital | Aspen, CO | $780 | $780 | $956.76 | 0.8× |
| UCHealth Highlands Ranch Hospital | Highlands Ranch, CO | $808.20 | $2,694 | $956.76 | 0.8× |
| UCHealth Memorial Hospital Central | Colorado Springs, CO | $824.40 | $1,832 | $956.76 | 0.9× |
| UCHealth University of Colorado Hospital | Aurora, CO | $906.50 | $2,590 | $956.76 | 0.9× |
| Lakeside Medical Center | Belle Glade, FL | $941.10 | — | $947.15 | 1.0× |
| Longs Peak Hospital | Longmont, CO | $942.90 | $2,694 | $967.38 | 1.0× |
| UCHealth Broomfield Hospital | Broomfield, CO | $942.90 | $2,694 | $956.76 | 1.0× |
| UCHealth Grandview Hospital | Colorado Springs, CO | $942.90 | $2,694 | $956.76 | 1.0× |
| Jupiter Medical Center | Jupiter, FL | $955 | $955 | $947.15 | 1.0× |
| Delta County Memorial Hospital | Delta, CO | $998.16 | $1,663.60 | $956.76 | 1.0× |
| Southwest Memorial Hospital | Cortez, CO | $1,082 | $2,163 | $956.76 | 1.1× |
| Southeast Colorado Hospital | Springfield, CO | $1,100 | $1,375 | $956.76 | 1.1× |
| Tampa General Hospital | Tampa, FL | $1,153.25 | $3,295 | $947.15 | 1.2× |
| AdventHealth Porter | Denver, CO | $1,224.63 | $1,224.63 | $956.76 | 1.3× |
| AdventHealth Avista | Louisville, CO | $1,224.63 | $1,224.63 | $967.38 | 1.3× |
| AdventHealth Littleton | Littleton, CO | $1,224.63 | $1,224.63 | $956.76 | 1.3× |
| AdventHealth Parker | Parker, CO | $1,224.63 | $1,224.63 | $956.76 | 1.3× |
| AdventHealth Castle Rock | Castle Rock, CO | $1,224.63 | $1,224.63 | $956.76 | 1.3× |
| Baptist Medical Center Jacksonville | Jacksonville, FL | $1,233.18 | $1,989 | $947.15 | 1.3× |
| Baptist Medical Center - Beaches | Jacksonville Beach, FL | $1,233.18 | $1,989 | $947.15 | 1.3× |
| Baptist Medical Center - Nassau | Fernandina Beach, FL | $1,233.18 | $1,989 | $947.15 | 1.3× |
| MedStar Washington Hospital Center | Washington, DC | $1,281.13 | $1,970.97 | $965.72 | 1.3× |
| Texas Health Harris Methodist Hospital Fort Worth (Texas Health Resources) | Fort Worth, TX | $1,339.65 | $2,232.75 | $911.12 | 1.5× |
| Parkland Memorial Hospital | Dallas, TX | $1,365.60 | $3,414 | $911.12 | 1.5× |
| UCHealth Greeley Hospital | Greeley, CO | $1,380.60 | $2,301 | $956.76 | 1.4× |
| Middle Park Medical Center | Kremmling, CO | $1,452.39 | $1,815.48 | $956.76 | 1.5× |
| MedStar Georgetown University Hospital | Washington, DC | $1,514.44 | $2,329.91 | $965.72 | 1.6× |
| UF Health Jacksonville | Jacksonville, FL | $1,558.86 | $2,834.29 | $947.15 | 1.6× |
| Poudre Valley Hospital | Fort Collins, CO | $1,610.70 | $2,301 | $956.76 | 1.7× |
| Medical Center of the Rockies | Loveland, CO | $1,610.70 | $2,301 | $956.76 | 1.7× |
| Wellington Regional Medical Center | Wellington, FL | $1,962 | $2,616 | $947.15 | 2.1× |
| AdventHealth Deland | Deland, FL | $2,733.29 | $2,733.29 | $947.15 | 2.9× |
| AdventHealth Orlando | Orlando, FL | $2,782 | $2,782 | $947.15 | 2.9× |
| Orlando Health Orlando Regional Medical Center | Orlando, FL | $2,862 | $7,155 | $947.15 | 3.0× |
| Orlando Health - Health Central Hospital | Ocoee, FL | $2,862 | $7,155 | $947.15 | 3.0× |
| Orlando Health Bayfront Hospital | Saint Petersburg, FL | $2,862 | $7,155 | $947.15 | 3.0× |
| Orlando Health South Lake Hospital | Clermont, FL | $2,862 | $7,155 | $947.15 | 3.0× |
| Orlando Health Sebastian River Hospital | Sebastian, FL | $2,862 | $7,155 | $947.15 | 3.0× |
| Orlando Health Melbourne Hospital | Melbourne, FL | $2,862 | $7,155 | $947.15 | 3.0× |
| Orlando Health St. Cloud Hospital | Saint Cloud, FL | $2,862 | $7,155 | $947.15 | 3.0× |
| AdventHealth Daytona Beach | Daytona Beach, FL | $2,869.95 | $2,869.95 | $947.15 | 3.0× |
| AdventHealth Fish Memorial | Orange City, FL | $2,869.95 | $2,869.95 | $947.15 | 3.0× |
| AdventHealth Lake Wales | Lake Wales, FL | $2,869.95 | $2,869.95 | $947.15 | 3.0× |
| AdventHealth Palm Coast | Palm Coast, FL | $2,869.95 | $2,869.95 | $947.15 | 3.0× |
| AdventHealth New Smyrna Beach | New Smyrna Beach, FL | $3,143.28 | $3,143.28 | $947.15 | 3.3× |
| Cleveland Clinic Martin North Hospital | Stuart, FL | $3,504.15 | $5,391 | $947.15 | 3.7× |
| Cleveland Clinic Indian River Hospital | Vero Beach, FL | $3,504.15 | $5,391 | $947.15 | 3.7× |
| Cleveland Clinic Hospital | Weston, FL | $3,504.15 | $5,391 | $947.15 | 3.7× |
| AdventHealth Sebring | Sebring, FL | $4,260.68 | $4,260.68 | $947.15 | 4.5× |
| AdventHealth Ocala | Ocala, FL | $5,945.48 | $5,945.48 | $947.15 | 6.3× |
| AdventHealth Zephyrhills | Zephyrhills, FL | $8,175.03 | $8,175.03 | $947.15 | 8.6× |
| AdventHealth Carrollwood | Tampa, FL | $8,175.03 | $8,175.03 | $947.15 | 8.6× |
| AdventHealth Tampa | Tampa, FL | $8,175.03 | $8,175.03 | $947.15 | 8.6× |
| AdventHealth Wesley Chapel | Wesley Chapel, FL | $8,175.03 | $8,175.03 | $947.15 | 8.6× |
| AdventHealth Riverview | Riverview, FL | $8,175.03 | $8,175.03 | $947.15 | 8.6× |
| AdventHealth North Pinellas | Tarpon Springs, FL | $9,376.59 | $9,376.59 | $947.15 | 9.9× |
| AdventHealth Dade City | Dade City, FL | $10,785.44 | $10,785.44 | $947.15 | 11.4× |
| Intermountain Health St. Mary's Regional Hospital | Grand Junction, CO | — | $2,688 | $956.76 | — |
| Intermountain Health Platte Valley Hospital | Brighton, CO | — | $2,694.70 | $956.76 | — |
| Intermountain Health Lutheran Hospital | Golden, CO | — | $2,720.60 | $956.76 | — |
| Intermountain Health St. Joseph Hospital | Denver, CO | — | $2,720.60 | $956.76 | — |
| Intermountain Health Good Samaritan Hospital | Lafayette, CO | — | $2,720.60 | $967.38 | — |
"Medicare pays" is the facility (technical) rate, matching the posted facility charge; the doctor's separate professional fee is excluded throughout. "—" means Medicare has no comparable facility rate.