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Pennsylvania rates for HCPCS 21440

Closed treatment of mandibular or maxillary alveolar ridge fracture (separate procedure)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$734.10 / $2,791.00 / $7,629.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$466.58 / $595.54 / $1,006.87
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$6,431.95 / $7,827.00 / $19,139.18
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$721.51 / $748.74 / $748.74
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.94 / $963.94 / $963.94
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$456.49 / $688.97 / $1,181.11
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$877.43 / $1,169.72 / $1,515.55
Highmark BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$8,807.75 / $8,807.75 / $8,807.75
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$768.00 / $3,838.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$485.85 / $640.61 / $2,740.44
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$348.90 / $348.90 / $1,489.80
Priority Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$963.94 / $963.94 / $963.94
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$464.45 / $700.31 / $1,212.42
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$235.11 / $533.26 / $662.25
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$294.33 / $576.83 / $718.82
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,334.00 / $2,824.00 / $5,678.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$469.75 / $706.59 / $1,229.78