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Alaska rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,458.07 / $9,577.00 / $14,552.94
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$449.26 / $2,472.92 / $3,302.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,257.56 / $1,759.61 / $2,907.77
Moda Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$612.64 / $2,472.92 / $4,623.39
Moda Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,189.55 / $2,013.57 / $4,046.25
Premera BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,838.75 / $2,801.25 / $4,192.50
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$612.64 / $2,720.22 / $4,623.39
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,098.88 / $2,899.75 / $4,282.39
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,839.42 / $2,774.96 / $4,046.72