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Alabama rates for HCPCS 21085

Impression and custom preparation; oral surgical splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,096.48 / $1,445.44 / $2,398.83
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$489.78 / $724.44 / $1,698.24
Ambetter
Facility/Professional
Professional
Modifier
Low / Median / High Price
$691.83 / $691.83 / $691.83
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$79.43 / $95.50 / $128.82
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$467.74 / $758.58 / $912.01
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$831.76 / $831.76 / $831.76
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$478.63 / $776.25 / $1,659.59
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$239.88 / $512.86 / $1,348.96
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$426.58 / $630.96 / $1,148.15