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Pennsylvania rates for HCPCS 40805

Removal of embedded foreign body, vestibule of mouth; complicated

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$303.54 / $2,747.00 / $8,017.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.24 / $264.14 / $401.28
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,344.69 / $3,159.00 / $14,886.03
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$281.89 / $292.52 / $292.52
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$216.40 / $328.33 / $564.22
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$337.48 / $446.52 / $459.58
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$918.00 / $3,120.00 / $8,017.00
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$193.92 / $284.37 / $1,117.51
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$5.00 / $274.60 / $928.00
Priority Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$227.25 / $341.40 / $577.66
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$192.00 / $246.33 / $345.89
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$191.37 / $270.77 / $294.95
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$162.00 / $557.00 / $3,742.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$260.44 / $367.61 / $588.16