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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
$954.99 / $3,890.45 / $8,317.64
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $281.84 / $676.08
Capital Blue Cross
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,630.27 / $2,691.53 / $57,543.99
Capital Blue Cross
Facility/Professional
Professional
Modifier
Low / Median / High Price
$302.00 / $302.00 / $302.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$213.80 / $316.23 / $562.34
Emblem Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$354.81 / $446.68 / $489.78
Geisinger
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $354.81 / $537.03
Martin's Point
Facility/Professional
Facility
Modifier
Low / Median / High Price
$912.01 / $2,818.38 / $8,317.64
Martin's Point
Facility/Professional
Professional
Modifier
Low / Median / High Price
$204.17 / $331.13 / $870.96
Oscar Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$275.42 / $275.42 / $602.56
Oscar Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$257.04 / $562.34 / $851.14
UPMC Health Plan
Facility/Professional
Facility
Modifier
Low / Median / High Price
$190.55 / $346.74 / $416.87
UPMC Health Plan
Facility/Professional
Professional
Modifier
Low / Median / High Price
$162.18 / $295.12 / $416.87
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$223.87 / $1,148.15 / $3,890.45
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$194.98 / $295.12 / $501.19