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California rates for HCPCS 21085

Impression & Preparation Oral Surgical Splint

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$720.83 / $7,648.00 / $20,135.00
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$502.25 / $656.03 / $2,738.28
Anthem BCBS
Facility/Professional
Facility
Modifier
Low / Median / High Price
$2,137.00 / $5,694.00 / $11,233.00
Anthem BCBS
Facility/Professional
Professional
Modifier
Low / Median / High Price
$615.88 / $885.14 / $1,634.66
Blue Shield
Facility/Professional
Facility
Modifier
Low / Median / High Price
$65.80 / $100.00 / $7,100.20
Blue Shield
Facility/Professional
Professional
Modifier
Low / Median / High Price
$522.65 / $746.64 / $1,610.18
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$243.77 / $244.20 / $2,277.00
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$573.70 / $815.87 / $1,552.06
Contra Costa Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$551.21 / $744.13 / $1,035.55
Kaiser Permanente
Facility/Professional
Professional
Modifier
Low / Median / High Price
$491.37 / $744.13 / $1,299.43
Lucent Health
Facility/Professional
Facility
Modifier
Low / Median / High Price
$55.00 / $2,226.84 / $2,420.51
Lucent Health
Facility/Professional
Professional
Modifier
Low / Median / High Price
$3,591.60 / $5,032.64 / $5,753.85
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.34 / $32.34 / $32.34
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$578.29 / $829.63 / $1,157.52
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$592.32 / $858.72 / $1,656.80
Sutter Health Plus
Facility/Professional
Professional
Modifier
Low / Median / High Price
$1,677.24 / $1,677.24 / $2,320.39
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$548.00 / $1,523.00 / $6,323.00
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$548.78 / $738.12 / $1,581.71