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Arizona rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$808.00 / $2,359.00 / $6,305.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$457.05 / $625.32 / $1,417.48
BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$438.60 / $1,651.20 / $2,700.74
BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$579.62 / $724.53 / $920.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$511.26 / $762.28 / $1,282.94
Medica
Facility/Professional
Facility
Modifier
Low / Median / High Price
$488.80 / $746.38 / $1,573.00
Medica
Facility/Professional
Professional
Modifier
Low / Median / High Price
$618.24 / $832.97 / $5,095.68
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$704.00 / $1,535.00 / $2,175.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$598.40 / $761.93 / $1,328.24