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Arkansas rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$679.53 / $934.00 / $3,109.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$508.36 / $679.53 / $960.77
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$211.37 / $211.37 / $253.64
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$521.94 / $728.08 / $963.63
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,734.43 / $1,734.43 / $1,734.43
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$704.66 / $973.42 / $1,271.13
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$130.00 / $328.00 / $768.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$630.16 / $941.62 / $1,290.95