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Massachusetts rates for HCPCS 41805

Removal of embedded foreign body from dentoalveolar structures; soft tissues

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$263.03 / $2,238.72 / $3,801.89
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $288.40 / $630.96
AllWays Health Partners
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $1,258.93 / $4,677.35
AllWays Health Partners
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $363.08 / $2,187.76
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $239.88 / $549.54
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$933.25 / $954.99 / $954.99
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$199.53 / $446.68 / $501.19
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $371.54 / $758.58
Fallon Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$204.17 / $436.52 / $7,079.46
Fallon Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$346.74 / $478.63 / $676.08
Harvard Pilgrim
Facility/Professional
Facility
Modifier
Low / Median / High Price
$616.60 / $3,162.28 / $8,511.38
Harvard Pilgrim
Facility/Professional
Professional
Modifier
Low / Median / High Price
$229.09 / $407.38 / $812.83
Mass General Brigham
Facility/Professional
Facility
Modifier
Low / Median / High Price
$56.23 / $1,258.93 / $4,677.35
Mass General Brigham
Facility/Professional
Professional
Modifier
Low / Median / High Price
$186.21 / $363.08 / $2,187.76
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$676.08 / $3,162.28 / $8,511.38
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$181.97 / $354.81 / $794.33